Description
Mount Sinai is one of the largest U.S. health systems with a strong reputation for quality of care and research. We have over 38,000 employees working together to provide billions of dollars in high-quality care each year for millions of patients.
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
What We Offer
- Opportunity for advancement within MSHP team
- Opportunity to work directly with senior leaders from across the Mount Sinai Health System and external organizations
- Opportunity for mentorship from senior MSHP leaders
- Opportunity to be part of a forward-thinking team driving a system-wide transformation
- Opportunity to work at the forefront of innovation in healthcare
The Managed Care Contracting Team within MSHP is responsible for the negotiation, implementation and contract compliance related to Facility Contracts for all Commercial, Medicare Advantage and Medicaid Managed Care Plans. The team serves as MSHP’s subject matter experts on: Facility related Agreements and Amendments, financial performance for all contracts, and facility, ancillary related contract negotiations. The Managed Care Team is at the forefront of implementing Facility and Ancillary Contracts across the Mount Sinai Health System.
MSHP seeks a Senior Contract Manager Analyst will play a critical role in testing, coding, modeling, and reporting on Hospital Billing (HB) and Professional Billing (PB) contracts for the MSHS Health System. This individual will ensure the accuracy of contract terms, reimbursement structures, and facilitate the flow of contract data into the revenue cycle system. A strong background in contract coding, logic, and the ability to interpret contract terms and reimbursement guidelines is essential. Revenue cycle experience is highly desirable.
Responsibilities
- Contract Testing & Validation:
- Conduct thorough testing of contract logic to ensure proper contract terms, rates, and reimbursement schedules are applied.
- Validate accuracy of system configurations for new and updated contracts.
- Coding & Modeling:
- Apply contract coding techniques to accurately map and model contracts within the healthcare system.
- Develop and maintain models that reflect reimbursement terms and other financial obligations outlined in contracts.
- Reporting & Analysis:
- Generate and analyze reports on contract performance, identifying discrepancies or issues impacting revenue.
- Provide actionable insights on contract-related data to enhance decision-making and optimize reimbursement.
- Contract Review & Interpretation:
- Analyze and interpret contract terms, conditions, and reimbursement guidelines to ensure alignment with financial goals.
- Work with legal, financial, and clinical departments to resolve discrepancies or ambiguities in contract language.
- Collaboration & Support:
- Collaborate with the Revenue Cycle team to integrate contract terms into billing, claims, and payment systems.
- Provide support and guidance to internal teams on complex contract issues and changes in reimbursement methodologies.
- Continuous Improvement:
- Identify and recommend process improvements related to contract administration, coding, and reporting.
- Assist in the development of best practices and standard operating procedures for contract management and coding.
Qualifications
EDUCATION REQUIREMENTS
- Bachelor’s degree in Business, Finance, Healthcare Administration, or a related field.
- Additional certifications (e.g., CPC, CCS, or related healthcare coding certifications) are a plus.
EXPERIENCE REQUIREMENTS
- Minimum 3-5 years of experience in contract management, coding, and analysis in a healthcare setting.
- Experience with Hospital Billing (HB) and Professional Billing (PB) contracts.
- Strong background in contract coding, logic, and reimbursement structures.
- Prior experience in revenue cycle management or financial operations within a healthcare organization is preferred.
ADDITIONAL SKILLS AND QUALITIES
- Strong analytical skills with the ability to interpret complex contract terms and financial data.
- Proficient in contract management systems, modeling software, and financial reporting tools.
- Familiarity with healthcare coding standards (e.g., CPT, ICD-10, HCPCS) and reimbursement methodologies.
- Excellent communication skills, both written and verbal, to effectively interact with cross-functional teams.
- Detail-oriented with a focus on accuracy and compliance.
PREFERRED SKILLS:
- In-depth knowledge of healthcare revenue cycle processes, including billing, claims management, and payment reconciliation.
- Familiarity with Stratajazz, Experian, and the Epic suite of products is a strong bonus.
- Experience working with contract management software systems (e.g., Contract Lifecycle Management systems, Epic, or other healthcare-specific platforms).
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