Director of Managed Care

Mount Sinai Medical Center of Florida•Miami Beach, FL

17h

About The Position

Mount Sinai Medical Center is seeking a Director of Managed Care to oversee hospital charge-audit activities and support accurate billing, contractual compliance, and effective audit operations. The role performs and oversees audits of patient records, tracks audit results, analyzes findings, and works with finance, clinical departments, the Business Office, Health Information Management, and Managed Care Contracting to address inaccuracies and improve processes. The position also monitors Medicare guidance and supports appropriate documentation, billing, and hospital pricing practices.

Requirements

Bachelor’s degree in Business, Accounting, or a related field.
At least 3 years of experience in healthcare reimbursement.
Prior lead or supervisory experience.

Responsibilities

Perform ongoing and retrospective charge audits of patient records to identify charging and billing weaknesses and potential compliance issues.
Conduct concurrent reviews of potential catastrophic cases to ensure charges are accurate.
Represent the hospital in charge-audit functions with insurance carriers and their representatives.
Manage audit tracking reports, including the Revenue Management Dashboard, Insurance Defense Audit, implant reviews, and S/L Threshold.
Monitor net audit results to ensure health plans comply with hospital and contractual audit terms.
Ensure daily and weekly reports are completed within allotted timeframes.
Analyze departmental audit findings using reports and charts, and present results to the VP of Finance and other appropriate parties.
Prepare the Monthly Audit Operations report, summarize audit activities, and identify potential inaccuracies.
Monitor clinical departments’ implementation of audit results and ensure corrective actions are completed by agreed deadlines.
Ensure insurance defense audits follow hospital audit protocols and contractual obligations.
Monitor CMS transmittals and communications to keep the Audit Team current with Medicare guidelines, and provide relevant resources to hospital departments.
Provide suggestions and examples to the chargemaster manager to support industry-standard pricing and compliance with government directives.
Identify weaknesses in contract language related to audit functions and provide feedback to Managed Care Contracting.
Educate ancillary departments on appropriate documentation and billing.
Monitor audit requests from the Business Office and other internal departments to ensure Audit Team resources are used effectively.
Communicate proactively with Business Office management to reduce unnecessary requests and provide education about audit functions.
Monitor trends in chart documentation and provide feedback to clinical departments or medical staff as needed.
Evaluate record-abstracting accuracy in conjunction with charges and documentation, and provide feedback to Health Information Management.