Easter Seals Jobs

JOB DESCRIPTION

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.

RESPONSIBILITIES

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.

QUALIFICATIONS

• 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

E01 - Partner MSO Services - MSH, Mount Sinai Hospital

REQUIRED SKILLS

MS Excel

MS Word

ABOUT US

Strength Through Diversity

The Mount Sinai Health System believes that diversity, equity, and inclusion are key drivers for excellence. We share a common devotion to delivering exceptional patient care. When you join us, you become a part of Mount Sinai’s unrivaled record of achievement, education, and advancement as we revolutionize medicine together. We invite you to participate actively as a part of the Mount Sinai Health System team by:

• Using a lens of equity in all aspects of patient care delivery, education, and research to promote policies and practices to allow opportunities for all to thrive and reach their potential.

• Serving as a role model confronting racist, sexist, or other inappropriate actions by speaking up, challenging exclusionary organizational practices, and standing side-by-side in support of colleagues who experience discrimination.

• Inspiring and fostering an environment of anti-racist behaviors among and between departments and co-workers.

At Mount Sinai, our leaders strive to learn, empower others, and embrace change to further advance equity and improve the well-being of staff, patients, and the organization. We expect our leaders to embrace anti-racism, create a collaborative and respectful environment, and constructively disrupt the status quo to improve the system and enhance care for our patients. We work hard to create an inclusive, welcoming and nurturing work environment where all feel they are valued, belong and are able to advance professionally.

Explore more about this opportunity and how you can help us write a new 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 43,000 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 approximately 7,400 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 and top 20 in Cardiology/Heart Surgery, 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. 14 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.

The Mount Sinai Health System is an equal opportunity employer. We comply with applicable Federal civil rights laws and does not discriminate, exclude, or treat people differently on the basis of race, color, national origin, age, religion, disability, sex, sexual orientation, gender identity, or gender expression. We are passionately committed to addressing racism and its effects on our faculty, staff, students, trainees, patients, visitors, and the communities we serve. Our goal is for Mount Sinai to become an anti-racist health care and learning institution that intentionally addresses structural racism.”

EOE Minorities/Women/Disabled/Veterans

Requisition ID : 3017564