Mount Sinai Careers
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Manager, C.I.N. Relations- Mount Sinai Health Partners
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.
MSHPseeks a report
· Resolving provider access and quality risk issues.
· Oversight of the Employee Top Tier Plan
· 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
· 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.
· 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.
Education and Experience
· 7+ years’ experience in Health System/Health Plan or healthcare related field