Associate Vice President, Contract Compliance & Performance

Mount Sinai Health System • New York, NY

1d

About The Position

The Associate Vice President of Contract Compliance & Performance provides enterprise leadership for the governance, monitoring, analytics, and performance management of payer contracts across the health system, including hospital, ambulatory, physician, and faculty practice operations. Reporting to the Vice President of Revenue Reporting and Intelligence, the AVP establishes the framework, processes, analytics, controls, and accountability necessary to ensure that payer contract terms are accurately interpreted, operationalized, monitored, and reflected in reimbursement outcomes. The AVP serves as the enterprise subject matter expert for payer contract performance and compliance and works collaboratively with Managed Care Contracting, Revenue Cycle, Finance, Compliance, Legal, Patient Financial Services, Physician Enterprise, Faculty Practice, Clinical Operations, Information Technology, Data & Analytics, and other stakeholders. The role is responsible for identifying and quantifying contract-performance opportunities and risks, monitoring actual versus expected reimbursement, establishing appropriate controls and escalation mechanisms, and driving resolution of material reimbursement variances. The AVP will develop and mature an enterprise Contract Compliance & Performance function that integrates contractual knowledge, reimbursement analytics, operational controls, data intelligence, and cross-functional accountability to improve financial performance, strengthen contractual compliance, and reduce revenue leakage and financial risk.

Requirements

• Bachelor's degree in healthcare administration, finance, business administration, accounting, health information management, or a related field.
• 12–15+ years of progressive experience in healthcare finance, payer contracting, reimbursement, revenue cycle, contract compliance, revenue analytics, or a related field.
• Significant leadership experience in payer contract performance, reimbursement analytics, payment validation, or related functions.
• Demonstrated experience within a large academic medical center, integrated delivery network, multi-hospital health system, or similarly complex healthcare organization.
• Experience spanning both facility and professional reimbursement environments strongly preferred.
• Demonstrated success leading enterprise initiatives across multiple business units and stakeholder groups.
• Experience partnering with senior executives across Managed Care, Finance, Revenue Cycle, Compliance, Legal, Clinical Operations, and Physician leadership.
• Demonstrated ability to translate complex contractual and reimbursement requirements into operational processes, controls, analytics, and measurable outcomes.
• Advanced knowledge of healthcare payer contracting and reimbursement.
• Strong understanding of hospital and professional reimbursement methodologies.
• Knowledge of Medicare, Medicaid, and commercial payer requirements.
• Understanding of DRG, APC, CPT, HCPCS, fee schedule, percentage-of-Medicare, and other reimbursement methodologies.
• Strong financial modeling and analytical capabilities.
• Ability to interpret complex contractual language and translate requirements into operational and system specifications.
• Knowledge of revenue cycle operations and healthcare financial processes.
• Understanding of healthcare compliance and regulatory requirements.
• Strong data analytics and performance-management capabilities.
• Experience developing executive dashboards and financial intelligence.
• Excellent executive communication and presentation skills.
• Demonstrated ability to influence across a highly matrixed organization.
• Strong negotiation, problem-solving, and conflict-resolution skills.
• Strategic thinking combined with strong operational execution.
• Change management and organizational transformation expertise.
• Ability to build relationships and drive results without direct authority across multiple organizational functions.

Nice To Haves

• Master's degree strongly preferred, including MBA, MHA, MPH, or related advanced degree.
• Experience within a major academic medical center or integrated academic health system.
• Experience with complex commercial, Medicare, Medicaid, and value-based reimbursement arrangements.
• Experience supporting payer negotiations and contract strategy.
• Experience with Epic hospital and professional billing environments.
• Experience with contract modeling, reimbursement analytics, or payment validation technologies.
• Experience developing enterprise dashboards, payer scorecards, and executive reporting.
• Experience with healthcare data analytics, automation, and artificial intelligence.
• Experience leading large-scale transformation or enterprise governance initiatives.
• Experience working in highly matrixed, complex healthcare organizations.
• Relevant professional certifications may be preferred, including: HFMA Certified Healthcare Financial Professional (CHFP), HFMA Certified Revenue Cycle Representative (CRCR), Project Management Professional (PMP), Other relevant healthcare finance, reimbursement, compliance, analytics, or revenue-cycle certifications.

Responsibilities

• Develop and execute the enterprise strategy for payer contract compliance and performance.
• Establish governance, accountability, and standardized processes for monitoring compliance with payer contract terms.
• Serve as the enterprise subject matter expert on the operational interpretation and implementation of payer contract provisions.
• Establish standards for monitoring contractual reimbursement, payment accuracy, contractual obligations, and payer performance.
• Develop mechanisms to identify, quantify, prioritize, and resolve material variances between contracted and actual reimbursement.
• Establish appropriate escalation processes for significant contract compliance issues, systemic payment variances, and material financial risk.
• Provide executive leadership with clear, actionable intelligence regarding payer performance, contractual risk, reimbursement trends, and financial opportunity.
• Develop a continuous-improvement framework to strengthen contract performance and reduce recurring reimbursement variance.
• Support organizational growth, affiliations, acquisitions, joint ventures, and new business arrangements by assessing contract-performance and reimbursement implications.
• Provide enterprise oversight for translating negotiated payer agreements, amendments, and reimbursement methodologies into operational and system requirements.
• Interpret complex payer contract provisions and translate them into operational and system requirements.
• Establish governance for contract implementation, configuration, testing, validation, and ongoing maintenance.
• Partner with Managed Care, Revenue Cycle, Finance, Information Technology, and operational leaders to ensure accurate implementation of contracted terms.
• Provide oversight of contract modeling, fee schedules, reimbursement rules, payment logic, and related system configurations.
• Establish pre-implementation and post-implementation validation processes.
• Monitor timely implementation of new contracts, amendments, rate changes, escalators, and other contractual provisions.
• Identify and escalate implementation discrepancies that may result in financial loss or compliance risk.
• Establish standardized documentation of contract interpretations, assumptions, requirements, and implementation decisions.
• Ensure changes to contractual terms are appropriately communicated to affected stakeholders and incorporated into applicable operational processes.
• Lead enterprise efforts to determine whether actual payer reimbursement aligns with contractual expectations.
• Establish methodologies for calculating expected reimbursement and identifying payment variances.
• Monitor actual versus expected reimbursement across applicable payer arrangements.
• Identify material underpayments, overpayments, payment variances, and other deviations from contractual expectations.
• Establish processes for prioritizing payment recovery and remediation opportunities.
• Analyze trends in reimbursement variance, denials, contractual adjustments, appeals, and other indicators of payer performance.
• Lead root-cause analysis of material or recurring reimbursement discrepancies.
• Partner with Revenue Cycle and operational leaders to implement sustainable corrective actions.
• Establish controls to monitor the effectiveness of remediation efforts.
• Distinguish isolated payment issues from systemic contract, operational, configuration, data, or payer-performance issues.
• Ensure identified systemic issues are addressed at their source rather than relying solely on retrospective recovery.
• Provide financial and operational analysis to support contract negotiations and renewals.
• Evaluate proposed reimbursement methodologies and contractual changes.
• Identify contract provisions that may create operational, financial, or compliance risk.
• Provide recommendations regarding contract language, reimbursement methodologies, payment provisions, and performance requirements.
• Analyze historical and projected payer performance to inform negotiation strategies.
• Support evaluation of new payer products, alternative payment arrangements, value-based contracts, and other reimbursement models.
• Provide objective performance data and financial intelligence to support payer relationship management.
• Collaborate with Managed Care leadership on escalation of material payer-performance issues.
• Support scenario modeling and financial impact analyses for proposed contractual changes.
• Establish an enterprise analytics and reporting framework that provides actionable intelligence regarding contract performance and reimbursement.
• Develop and maintain reporting and dashboards addressing: Contracted versus actual reimbursement, Payment accuracy, Contract performance, Payment variance, Underpayment and recovery opportunities, Payer performance, Denial and appeal trends, Contract implementation status, Financial impact of contractual provisions, Material compliance and performance risks, Resolution status of identified variances.
• Establish standardized definitions, methodologies, and performance measures for contract compliance reporting.
• Partner with Revenue Reporting and Intelligence to integrate contract-performance data with enterprise revenue and financial reporting.
• Develop executive dashboards and payer scorecards.
• Ensure data used for contract-performance analysis is accurate, timely, consistent, and appropriately governed.
• Develop predictive and advanced analytics to identify emerging risks and opportunities.
• Leverage automation and artificial intelligence, where appropriate, to improve monitoring, variance detection, prioritization, and workflow.
• Translate complex reimbursement data into actionable recommendations for executive and operational leaders.
• Establish a risk-based framework for monitoring compliance with payer contractual obligations and applicable reimbursement requirements.
• Develop risk-based contract compliance monitoring and audit methodologies.
• Establish periodic reviews of high-risk, high-value, or strategically significant contractual provisions.
• Coordinate with Corporate Compliance, Internal Audit, Legal, Finance, Revenue Cycle, and other oversight functions as appropriate.
• Support internal and external audits involving payer reimbursement and contractual compliance.
• Monitor applicable federal and state reimbursement requirements and assess operational implications.
• Ensure contract compliance processes appropriately incorporate applicable Medicare, Medicaid, commercial payer, and state requirements.
• Identify and escalate material contractual, financial, operational, and compliance risks.
• Establish documented corrective-action and remediation processes.
• Maintain appropriate documentation supporting contract interpretations, monitoring activities, findings, and resolutions.
• Provide executive oversight for significant payer payment disputes and recovery activities.
• Establish criteria for escalation of significant or high-value payment disputes.
• Oversee complex contractual reimbursement disputes.
• Support resolution of disagreements involving contract interpretation or payment methodology.
• Monitor recovery activity, outcomes, and trends.
• Partner with Managed Care and Legal on escalated payer disputes.
• Support arbitration, formal dispute resolution, or other escalation processes when appropriate.
• Identify systemic issues underlying recurring disputes and coordinate corrective action.
• Establish reporting on recovery performance, unresolved disputes, and material payer issues.
• Partner with Information Technology, Revenue Cycle technology teams, Data & Analytics, and Revenue Reporting and Intelligence to ensure technology capabilities support contract compliance and performance management.
• Provide strategic oversight for capabilities including: Contract modeling and management, Hospital and professional billing systems, Contract configuration and payment logic, Expected reimbursement modeling, Payment variance analytics, Enterprise data warehouse and reporting, Automated monitoring and exception identification, Data visualization and executive reporting, Advanced analytics and AI-enabled payment validation.
• Establish requirements for contract-performance data and analytics.
• Ensure appropriate controls for data quality, system configuration, testing, and change management.
• Participate in system and technology roadmap planning.
• Evaluate emerging technologies that may improve contract monitoring and performance.
• Partner with IT to ensure contract changes are accurately reflected in relevant systems.
• Establish ongoing validation of critical contract-related system configurations and data.
• Establish and maintain governance structures that support consistent enterprise management of contract compliance and performance.
• Define roles, responsibilities, decision rights, and escalation pathways.
• Establish enterprise standards for contract-performance monitoring.
• Develop governance forums and reporting structures as appropriate.
• Maintain clear interfaces between Contract Compliance & Performance, Managed Care, Revenue Cycle, Finance, Compliance, Legal, and other functions.
• Identify and resolve gaps or duplication in organizational accountability.
• Establish policies, procedures, standards, and controls supporting contract compliance.
• Promote consistent methodologies across hospital and professional environments while accounting for differences in contractual arrangements and operational requirements.
• Provide strategic leadership for the Contract Compliance & Performance function.
• Develop and execute the strategic roadmap for Contract Compliance & Performance in alignment with the broader Revenue Reporting and Intelligence strategy.
• Establish organizational structure, roles, responsibilities, and decision rights.
• Develop annual operating plans, strategic priorities, and measurable performance objectives.
• Establish executive reporting and performance-management mechanisms.
• Provide regular updates to executive leadership regarding contract performance, material risks, financial opportunities, and remediation.
• Lead enterprise initiatives involving reimbursement analytics, contract performance, financial intelligence, and revenue-cycle transformation.
• Manage departmental budgets, resources, and priorities.
• Recruit, develop, and retain high-performing talent.
• Establish succession planning and workforce development strategies.
• Foster a culture of accountability, collaboration, innovation, and continuous improvement.
• Represent Contract Compliance & Performance on enterprise governance committees and strategic initiatives.
• Serve as a trusted advisor to senior leadership on payer performance and contractual reimbursement matters.
• Lead a multidisciplinary team responsible for enterprise Contract Compliance & Performance capabilities, which may include: Contract Compliance, Contract Performance Analytics, Payment Validation, Contract Modeling, Reimbursement Analytics, Payer Performance Reporting, Audit and Monitoring, Data and Reporting.
• Strategic planning
• Workforce planning
• Budget management
• Talent acquisition and development
• Performance management
• Succession planning
• Process improvement
• Change management
• Executive communication
• Team engagement and retention
• Develop and maintain effective executive partnerships across the organization, including: Revenue Reporting and Intelligence, Revenue Cycle, Managed Care Contracting, Finance, Corporate Compliance, Legal, Patient Financial Services, Physician Enterprise, Faculty Practice, Clinical Operations, Health Information Management, Coding, Information Technology, Data & Analytics, Internal Audit, Enterprise Risk Management.
• Establish clear functional interfaces and accountability across these areas to ensure effective execution while avoiding duplication of responsibilities.

Benefits

• 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 $230,705.17 - $327,599.05 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager