Administrative Manager (Contract Support Professional)

This role’s primary focus is on assisting the FPA Departments, Network Practices, Revenue Managers, Central Billing Office (CBO) and Change Departments with key aspects of Managed Care contracting support including communication, fee schedule access, interpretation, compliance and problem resolution.  This role develops and maintains strong payer and provider relationships and positively positions the MSHP IPA in both communities. This position provides contract support for the top four national payers as well as the NYSHIP and UMR plans, including the Mount Sinai Employee health plan. 

1.    Lead contract implementation efforts for MSHS facilities.  Contract implementation tasks include but are not limited to communication to MSHS stakeholders on key contract terms, rate install, system setup and testing.
2.    Work in conjunction with internal matrix partners (PFS, Appeals, UM/CM) to identify, categorize and track issues related to payer contracts.  This includes the creation and maintenance of a standardized escalated payer issue tracking tool that, at minimum, documents and categorizes, sizes, and root causes issues as well as tracks progress for open items. Tracker will be utilized in payer conversations.
3.    Work in conjunction with the payer on promptly resolving issues impacting revenue.  Oversee internal and external governance processes.
4.    Contribute to the achievement of business goals related to contract yield, revenue growth, operational efficiencies and market share.
5.    Collaborates cross- functionally with PFS, Appeals, UM/CM and other internal stakeholders on more complex issues to ensure facility needs are met and outstanding issues are identified and resolved.
6.    Oversee and supports the national payer contracts, acting as managed care liaison for internal and external constituents in all facility matters.
7.    Function as managed care SME. Schedules and leads regular meetings with key stakeholders to clarify and address facility managed care contracts with regard to language, pricing, claims submission and appeals, claims adjudication and coverage policies, as well as billing/coding changes,
8.    Build and maintain effective relationships with payers and their teams. This extends to building trust and credibility that foster success, even when significant disputes may arise. 
9.    Establish and lead regular operations calls with payers to proactively discuss issues that may impact our contracts, specifically from a revenue perspective, progress on ongoing issues,
as well as notification of payer changes such as new or terminating plans, 
10.    Collaborate cross-functionally to resolve all escalated managed care issues received from internal partners ensuring prompt resolution of issues and maximizing revenue. 
11.    Collaborate with internal partners on implementing organizational policy and procedures. Attend internal meetings as required e.g. team meeting, PFS/Finance meeting etc.
12.    Maintain managed care educational tools such as payer product participation grid and internal and external contact lists
13.    Provide input for new/renewal agreements on pricing and language changes.
14.    Inform and discuss outstanding operational, enrollment and/or compliance issues with leadership. 
15.    Support and participate in payer settlement agreements. 
16.    Collaborates with on escalated revenue cycle initiatives and operational processes with a financial impact.
17.    Inform and educate providers /Departments on new and impactful payer coverage and claims payment policies. Work with Communications on large scale notifications.
18.    Assist MSHP and MSHS on special projects as assigned.
19.    Performs other related duties.
 

• Bachelor’s degree in business or public administration or related field, Masters preferred
• 8+ years experience in an administrative or management capacity, with preferred experience in the oversight of multiple areas or departments
• Strong leadership and problem solving skills
• Excellent written, oral and interpersonal communication skills
• Knowledge of operational analysis and decision-making techniques for resource allocation and organizational effectiveness
   

Compensation Statement

The Mount Sinai Health System (MSHS) provides a salary range to comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for this role is $91,999.97 - $142,500.02 Annually. Actual salaries depend on a variety of factors, including experience, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.

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