Director, Hospital Contract Support – Mount Sinai Health Partners

Job Description

The Mount Sinai Health System

Director, Hospital Contract Support

Managed Care Contracting Department


Background

The Mount Sinai Health System (MSHS) is one of the largest non-profit health systems in the U.S. with a strong reputation for quality of care and research/education. Our health system has 42,000 employees working together to provide billions of dollars of high-quality care for millions of patients each year.

We are accelerating our transition to a population health management business model with a goal to help entire communities achieve optimum health through active engagement with MSHS care givers.  Mount Sinai Health Partners (MSHP) is the team driving this transformation within the Mount Sinai Health System.  The team includes 400+ employees with clinical, contracting, financial, IT, analytics, operations, and product development and commercialization expertise.  MSHP is a fast growing business unit within the Mount Sinai Health System and is looking for team members who:

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

Work productively and decisively in an emerging  fluid environment

Thrive in fast-paced  work environments

Are hands on, willing to roll up their sleeves and dive in to get the job done

Seek to improve the status quo 

Within MSHP, the Managed Care Contracting group is responsible for contracting, contract management and servicing of payer organizations under contract with MSHS.  This team manages relationships, contracting and contract performance with payers to ensure optimal economics and operational performance.  The team is responsible for negotiating and servicing those contracts with payers for hospital, professional and ancillary services.

 

Role Summary

MSHP seeks a Director, Hospital Contract Support (DHCS), who will be responsible for the management and development of the analyses of MSHS’s performance under managed care ancillary, hospital and facility contract arrangements. The DHCS will establish the policies, procedures, and business processes to ensure oversight of MSHS hospital and facility contract performance and will lead the analysis process in support of potential contracts which MSHS may enter. The DHCS will ensure payers are reimbursed in line with their contracts, and drive audit and recovery processes in partnership with Patient Accounts as appropriate. The DHCS will report to the Vice President of Payer Contracting

The Director ensures optimal results are achieved with high employee engagement, while adhering to institutional policies and any applicable regulatory requirements.

 

Responsibilities

1.       Responsible for the development, implementation, standardization and use of reporting tools to monitor MSHS and Payer compliance with hospital and facility managed care and population health management contract arrangements. These tools include the Microsoft Office programs, Concuity, Experian, EPSI, Crimson and other electronic tools. 

2.      Maintains the business intelligence reporting frameworks, tools, and data marts while working cross-functionally with various MSHS department leaders to ensure high-quality hospital and facility contract reporting and analytics.

3.      Develops and coordinates analyses of hospital and facility contracts and the operational impact of various contracts. Drives resultant or other audits and recovery projects to ensure receipt of billed revenue through settlements or rate revisions.

4.      Supports the negotiation of hospital and facility contracts and implementation of these agreements.

5.      Oversees, coordinates and supports Joint Operation Committee (JOC) meetings with the Payer. 

6.      Project manages, coordinates and tracks contractual issue resolution. 

7.      Collaborates with the Information Technology and other departments to implement electronic tools to track, monitor, and evaluate MSHS hospital and facility contract performance.

8.      Prepares and/or coordinates financial and utilization analyses to develop and evaluate compensation methodologies and rate proposals, under payment, denial and retro rate recoveries and adjustments.

9.      Delivers regular reports to executive leadership on the performance of MSHS hospital and facility network related to quality, efficiency, and process measures.

10.  Leads strategic discussions with market leadership teams, senior management, and others, resulting in development and successful execution of coordinated institutional contracting plans based on data analysis and reporting trends.

11.  Manages operations within assigned department or division; uses data and fact-based problem solving techniques to improve processes and outcomes.  Ensures that all operations run according to institutional and departmental policies and in accordance with any government or regulatory requirements as applicable.

12.  Assists in the planning, development, and/or maintains departmental standard operating procedures. Regularly reviews policies and procedures and makes recommendations for changes to superiors as necessary.

13.  Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies.

14.  Provide leadership for in the form of ongoing training, goal setting, and problem resolution to cultivate a culture of innovation and creativity in service of better patient care.

15.  Performs all other duties as assigned.

 

Collaboration and Leadership

Collaborates with other business units to understand strategic goals and promote an environment conducive to creativity, change and information exchange. 

Assists in the training, coaching, mentoring of staff in accordance with all internal policies and procedures. Communicates values, strategies, and objectives of department or division on a regular basis. Assigns accountabilities, delegate’s tasks and responsibilities as appropriate.

Qualifications                   

Education and Experience

BA required, MBA or advanced business degree in related finance or health care discipline preferred.

Minimum 7 years’ experience in managed care contracting, hospital reimbursement, billing, and/or

contracting.

Demonstrated experience in data analytics and reporting tools for contracting arrangements.

Demonstrated experience in business development.

Superior written and verbal communication skills.

 

Additional Skills and Qualities

Advanced abilities in Microsoft Office Suite (Word/Excel/PowerPoint).

Clearly conveys information, data and concepts in a manner which engages the audience and helps them understand and retain the message.

Identifies and understands issues, challenges and opportunities; develops effective courses of action or appropriate solutions and follow through to ensure closure. Takes action consistent with available facts, constraints, and probable consequences.

Builds a successful team using appropriate methods and a flexible interpersonal style to create a cohesive team focused on meeting goals and objectives.

Maintains effectiveness when experiencing opposition, working under pressure or during major changes in work responsibilities or environment; adjusts effectively to work within new work structures, processes, requirements, or cultures.

Interacts with others to build trust and provide confidence in one’s intentions and those of the organization.

Sets high goals for personal and group accomplishments using measurable methods to monitor progress, tenaciously working to meet or exceed goals.

Provides feedback, instruction, and development guidance to help others excel in their current or future job responsibilities.

 

 

The Mount Sinai Health System is an equal opportunity employer. We promote recognition and respect for individual and cultural differences, and we work to make our employees feel valued and appreciated, whatever their race, gender, background, or sexual orientation. 

 


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