JOB DESCRIPTION

Director- Hospital Contract Support- Mount Sinai Health Partners

The Director, Hospital Contract Support manages all operational aspects of hospital managed care agreements. This includes but is not limited to, contract implementation, audits, rosters, accuracy of fee schedule linkage, and facilitation of the resolution of escalated operational and claims issues. The Director, Hospital Contract Support is a key member of the managed care contract operations leadership team ensuring accomplishment of objectives under the direction of MSHP senior leadership.

RESPONSIBILITIES

• Directly supervises, and coordinates the Hospital Contract Support team in the adherence to all operational functions and activities including operational policies and procedures, in accordance with standards established by the Third-Party Contract, Health System, institutional, governmental, and other regulatory bodies to achieve proper revenue growth and budgetary goals.

• Supports the system’s strategic mission, goals, policies and procedures, budget, work standards in coordination with system leadership.

• Develop and maintain relationships with leadership from matrix partners within MSHS.

• Develop and maintain excellent relationships with key stake holders e.g. Finance, PFS, Appeals Management, Clinical Operations, UM/CM, Legal etc., functioning as a managed care resource and problem solver.

• Develop and maintain effective relationships with managed care organizations (MCOs), functioning as management liaison for facility managed care issues.

• Direct, and participate in Payer joint operating committee (JOC) meetings that enable appropriate Mount Sinai and payer representatives to discuss and resolve payment and operational issues.

• Acts as a subject matter expert (SME) on facility managed care agreements and operations within the organization

• Assures timely notification, tracking, resolution and compliance with contractual dispute resolution processes, including working with internal and external staff and legal counterparts.

• Works cross functionally with internal stake holders to regain revenue lost /associated with contractual operational problems and contract non-compliance.

• Collaborates with PFS on revenue cycle initiatives and operational processes with a financial impact.

• Informs and educates matrix partners on new and impactful MCO coverage and claims payment policies. Works with Communications on large scale notifications.

• Directly manages complex MCO claims resolutions with significant liability, which may require escalation to legal for compliance and enforcement of contact terms.

• Aligned with managed care contracting, compliance, operations, ACO, and financial leadership in achievement of health system goals

• Assist managed care contracting in the development of language and financial proposals to ensure the needs of the system are met.

• Works closely with Senior Medical Director, Managed Care and Billing on matters impacting revenue and system dissatisfaction.

• Develops and assists in the selection, employment, development, and management of employees and allocation of resources.

• Responsible for working on all enrollment issues related to physician, group, departmental, facility, and health system, which may impact directories, websites, claims, utilization management, or other areas where network accuracy is critical.

• Responsible for adhering to personnel policies and practices. Provides oversight of the performance appraisal process, disciplinary action, and identification of skills training.

• Ensures the development and delivery of required staff training using a competency-based assessment program. Evaluate and develop staff based on job-specific competencies. Evaluates how staff resources are allocated to support business activities and revenue cycle initiatives.

• Handles special projects, committee assignment as assigned by the direct supervisor. VP, or SVP

• Performs other related duties.

QUALIFICATIONS

• Bachelors Degree required, Masters degree preferred

• 5 years? experience in managed care, either in provider and MCO settings.

• 7 years preferred

Non-Bargaining Unit, E01 - Partner MSO Services - MSH, Mount Sinai Hospital

REQUIRED SKILLS

MS Excel

MS PowerPoint

MS Word

Outlook

ABOUT US

Strength Through Diversity

The Mount Sinai Health System believes that diversity, equity, and inclusion are key drivers for excellence. We share a common devotion to delivering exceptional patient care. When you join us, you become a part of Mount Sinai’s unrivaled record of achievement, education, and advancement as we revolutionize medicine together. We invite you to participate actively as a part of the Mount Sinai Health System team by:

• Using a lens of equity in all aspects of patient care delivery, education, and research to promote policies and practices to allow opportunities for all to thrive and reach their potential.

• Serving as a role model confronting racist, sexist, or other inappropriate actions by speaking up, challenging exclusionary organizational practices, and standing side-by-side in support of colleagues who experience discrimination.

• Inspiring and fostering an environment of anti-racist behaviors among and between departments and co-workers.

At Mount Sinai, our leaders strive to learn, empower others, and embrace change to further advance equity and improve the well-being of staff, patients, and the organization. We expect our leaders to embrace anti-racism, create a collaborative and respectful environment, and constructively disrupt the status quo to improve the system and enhance care for our patients. We work hard to create an inclusive, welcoming and nurturing work environment where all feel they are valued, belong and are able to advance professionally.

Explore more about this opportunity and how you can help us write a new chapter in our history!

“About the Mount Sinai Health System:

Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,400 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 14 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.

The Mount Sinai Health System is an equal opportunity employer. We comply with applicable Federal civil rights laws and does not discriminate, exclude, or treat people differently on the basis of race, color, national origin, age, religion, disability, sex, sexual orientation, gender identity, or gender expression. We are passionately committed to addressing racism and its effects on our faculty, staff, students, trainees, patients, visitors, and the communities we serve. Our goal is for Mount Sinai to become an anti-racist health care and learning institution that intentionally addresses structural racism.”

EOE Minorities/Women/Disabled/Veterans

Requisition ID : 3017550