The Mount Sinai Health System
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:
Ø Are comfortable “playing up” and “playing down” as needed to accomplish business objectives
Ø Work productively and decisively in an emerging fluid environment
Ø Thrive in fast-paced work environments
Ø Are hands on, willing to roll up their sleeves and dive in to get the job done
Ø Seeks to improve the status quo
Within MSHP, the Managed Care Contracting group is responsible for negotiating contracts with payers for hospital, professional, ancillary and value and risk based services. The team manages these relationships and contract performance to ensure optimal financial and operational performance.
The Manager, Hospital Contract Support (MHCS) is responsible for managing operational and financial reimbursement issues relating to hospital and facility agreements between MSHS and contracted payers. The MHCS ensures the all procedures are followed according to institutional policies and any applicable regulatory requirements. The MHCS will be responsible for supporting the management and development of analyses to monitor and measure MSHS’s performance under managed care hospital and facility contract arrangements and will assist in the analysis for potential contracts into which MSHS may enter. The MHCS will report to the Director of Hospital Contract Support.
1. Works cross-functionally with various MSHS departments to ensure high-quality hospital and facility contract reporting and resolution of operational matters, such as billing issues and audits, in collaboration with payers.
2. Supports the negotiation of hospital and facility contracts and implementation of these agreements.
3. Supports the management of Joint Operation Committee (JOC) meetings with Payers for MSHS.
4. Project manages, coordinates and tracks contractual issue resolution.
5. Supports the preparation of financial and utilization analyses to develop and evaluate compensation methodologies and rate proposals, under payment, denial and retro rate recoveries and adjustments.
6. Collaborates with other business units to understand strategic goals and promote an environment conducive to creativity, change and information exchange.
7. Uses data and fact-based problem solving techniques to improve processes and outcomes.
8. Ensures that all operations run according to institutional and departmental policies and in accordance with any government or regulatory requirements as applicable.
9. Assists in the training, coaching, mentoring of staff in accordance with all internal policies and procedures.
10. Maintains departmental standard operating procedures. Regularly reviews policies and procedures and makes recommendations for changes to superiors as necessary.
11. Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications.
12. Articulates project needs and identifies data shortcomings and challenges.
13. Must have the ability to evaluate, understand and interpret data and communicate results effectively, both verbally and in writing. Must understand healthcare data warehouse structure as well as internal business objectives in order to extract and organize relevant data for reporting and analysis.
14. Participates in ongoing department process improvement initiatives.
15. Performs related duties and special projects, as assigned.
16. Maintains patient/employee confidentiality in the management of information
17. Implements and maintains established Health Care System policies and procedures
18. Performs all other duties as assigned.
19. Participates in the department’s performance improvement activities.
20. Maintains patient/employee confidentiality in the management of information.
21. Observes the health care system’s compliance policies.
22. Ensures proper care of departmental facilities, equipment, and supplies.
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.
Education and Experience
· Demonstrated experience in contract implementation and compliance.
· Strong written and verbal communication skills.
Additional Skills and Qualities
· 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; comparing data from different sources to formulate conclusions, develop an effective course of action or appropriate solution and follow through to ensure appropriate closure. Takes action consistent with available facts, constraints, and probable consequences.
· 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 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.