Senior Contracting Compliance Analyst - Professional Billing - Mount Sinai Health Partners

Mount Sinai Health System • New York, NY

1d

About The Position

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 (Professional Billing) Analyst who will primarily be responsible for tracking, trending, and analyzing professional billing (PB) contract compliance issues. This role requires a strong focus on identifying violations in PB 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.

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.
• 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.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees