Mount Sinai Careers

Manager, C.I.N. Relations- Mount Sinai Health Partners

New York, New York
Professional / Managerial / Administrative


Job Description

 

Mount Sinai is one of the largest non-profit health systems in the U.S. with a strong reputation for quality of care (18th ranked academic medical center) and research/education (22nd ranked medical school). Our health system has ~40,000 employees working together to provide billions of dollars in high-quality care for millions of patients each year.

 

We are accelerating a transition to a business model focused on population health management – our goal is to keep entire communities healthy and out of the hospital.  Mount Sinai Health Partners (MSHP) is the team driving this transformation within Mount Sinai.  The team includes 400+ employees with clinical, contracting, finance, IT, analytics, operations, and product development expertise. 

 

MSHP is a fast growing business unit within Mount Sinai and is looking for team members who:

 

·         Are comfortable “playing up” and “playing down” as needed to accomplish business objectives

·         Work productively amidst ambiguity

·         Thrive in fast-paced  work environments

·         Seek to improve the status quo 

 

Within MSHP, the Mount Sinai Health Partners, IPA; hosts a select network of physicians as well as the affiliated hospitals of the Mount Sinai Health System: The Mount Sinai Hospital, Mount Sinai Beth Israel, Mount Sinai Brooklyn, Mount Sinai St. Luke’s, Mount Sinai West, New York Eye and Ear Infirmary of Mount Sinai, and Mount Sinai Queens.

 

Role Summary

MSHP seeks a Manager, C.I.N. Relations who will report up to the Director of C.I.N. Relations. Manager will act as primary point of contact for troubleshooting co-branded payer issues among Oscar, Bright Health, Aetna Whole Health and other relationships within the C.I.N. under Mount Sinai Health Partners. This includes addressing operational or revenue cycle issues in a timely manner while identifying proactive ways to improve processes and ensure a mutually beneficial relationship. Oversight of the Employee Top Tier Plan including overseeing key accounts including Valley Hospital, ENT Allergy Associates, City MD as well as lead for expansion efforts for  Network gaps. All this while maintaining patient/employee confidentiality. Ensure high level provider satisfaction through focused customer service and promoting educational discussions around operational and member engagement expectations. Ensure that claims issues are addressed timely and accurately. Ensure TPA/Health System receives the initial Member Reports from Health Plans for those Members assigned to the IPA Physicians contained on the above Provider Rosters. Collaborates with health system departments and outside Health Plans, Providers, and Vendors to facilitate contract implementation. Coordinates, compiles and tracks financial and statistical information related to contract development and financial impact analysis. Coordinating the taking of meeting minutes of any internal/external meeting. Coordinate and Document progress on Contract Agreements. Oversee Top Tier contract load and fee schedules with both TPA and internal systems. Maintain, update, and coordinate responses related to Top Tier Network issues. Work on communication plan on Top Tier Network Access and Availability to the internal health system assets and overall network of physicians of IPA. Ensure timeframes are met by both Parties related to review and responses to redline versions of Contracts going back and forth between TPA and Health Systems.

Document internally any proposed barriers or “fatal flaws” and work on setting up necessary ad-hoc meetings to discuss such issues and resolve. Maintain and publish Contract Summaries for CIN high profile groups. Review network gaps in and outside of the Mount Sinai Health System footprint.

Responsibilities

Responsibility #1

·         Resolving provider access and quality risk issues.

·         Oversight of the Employee Top Tier Plan

 

Responsibility #2

·         Facilitate any additions to the MSHP / Top Tier Network in order to expand access for Employees.

·         Responds to inquiries and interprets contract language as it relates to Employee Plan Network access

Responsibility #3

·         Maintain Dashboard Reporting on Top Tier Network & coordinate with TPA resolutions to Provider issues where Providers may have hit a barrier in resolving directly with the Payers.

·         Conduct root cause analysis of any large claims projects submitted. Identify and address provider set-up issues that lead to claims problems.

Responsibility #4

·         Assessing network adequacy, oversight of key operational metrics, including audit performance expectations are all key components to identify opportunities to improve network performance and satisfaction.

·         Serves as subject matter expert in the development and implementation of reimbursement and revenue cycle strategies in conjunction with corporate expansion efforts.

 

Qualifications                   

Education and Experience

  • Bachelor’s Degree in Health Administration or related field or the equivalent combination of training and experience is required.

·         7+ years’ experience in Health System/Health Plan or healthcare related field

  • Experience with and knowledge of compliance with regard to required contract guidelines or regulations for government regulated lines of business and experience with direct oversight of provider education and provider grievances with processes and requirements.
  • Project management experience; must possess strong communication skills both in verbal and written form.  
  • Microsoft Word – Experience creating and writing documents.
  • Microsoft Excel – Experience creating spreadsheets, manipulating and formatting data.
  • Microsoft PowerPoint – Experience creating and editing presentations.
  • Proficient in WORD, Access, EXCEL, PowerPoint preferred