Job Description
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.
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 Compliance (Hospital Billing) Analyst who will primarily be responsible for tracking, trending, and analyzing hospital billing (HB) contract compliance issues. This role requires a strong focus on identifying violations in HB contract terms, escalating significant issues to Directors for potential legal intervention, and assisting in the escalation of claims that may require involvement from insurance carriers or legal entities. The ideal candidate should have a comprehensive understanding of the revenue cycle, contract management, and a keen eye for detail in identifying potential compliance risks.
Responsibilities - Track and Trend Compliance Issues:
- Monitor contract terms and conditions for adherence across all claims, identifying patterns of non-compliance.
- Conduct trend analysis and provide data-driven insights into recurring issues or contract violations.
- Escalation of Compliance Issues:
- Proactively escalate issues to Directors that could lead to significant legal ramifications or require intervention by external parties.
- Collaborate with the legal team to assess the potential risks and consequences of non-compliance.
- Claims Analysis and Summary Development:
- Develop detailed summaries of claims and issues that need to be escalated to insurance providers or legal entities for resolution.
- Review hospital and professional claims processes to identify gaps and discrepancies, ensuring compliance with contract agreements.
- Contract Term Enforcement:
- Analyze contract language to ensure proper interpretation and application of terms during claims processing.
- Ensure that all contract terms are being adhered to in day-to-day operations, providing corrective actions where necessary.
- Collaboration with Internal Teams:
- Work closely with the finance, legal, and billing departments to address complex compliance issues that may arise.
- Liaise with external vendors or insurance carriers regarding claims that require third-party intervention or negotiation.
- Revenue Cycle Expertise:
- Apply deep understanding of the revenue cycle, particularly in hospital and professional claims, to evaluate the compliance of claims and identify contract violations.
- Ensure that processes related to claims submission, payment, and reimbursement are in compliance with both internal policies and external regulations.
Qualifications Education Requirements
- HS/GED; Bachelors strongly preferred. Additional experience needed in addition to ?experience requirements? listed below in lieu of education.
Experience Requirements - Minimum of 7 years of experience in contract compliance, healthcare compliance, or revenue cycle management, with a strong understanding of both hospital and professional claims processes.
- Previous experience in a role that involved analyzing contracts, escalating issues, and working with legal teams or insurance plans.
Additional Skills And Qualities - Strong analytical skills with the ability to identify trends and root causes of non-compliance.
- Excellent communication skills, both written and verbal, with the ability to create clear, concise reports and summaries.
- Ability to work independently and manage multiple priorities in a fast-paced environment.
- Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint) and familiarity with healthcare billing systems.
- Deep understanding of the revenue cycle, hospital and professional claims processes, and related regulations.
- Familiarity with contract terms, NYS regulations, claims processing, and healthcare reimbursement models.
- Experience in working with insurance plans and understanding of claim adjudication processes.
Non-Bargaining Unit, E01 - Partner MSO Services - MSH, Mount Sinai Hospital
Employer Description Strength through Unity and Inclusion The Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai’s unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. We encourage all team members to actively participate in creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual.
At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally. Explore this opportunity and be part of the next chapter in our history.
About the Mount Sinai Health System: Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes more than 9,000 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 11 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.
Equal Opportunity Employer The Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. We are deeply committed to fostering an environment where all faculty, staff, students, trainees, patients, visitors, and the communities we serve feel respected and supported. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization.
Compensation The Mount Sinai Health System (MSHS) provides salary ranges that comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $96461 - $144692 Annually. Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.
Job Tags
Contract work, Traineeship, Work at office, Local area,