Enterprise AVP, Payer Contract Performance

Mount Sinai Health System; United States; On-site; USD 231,000 - 328,000; Full time

Benefits offered by this job

Mount Sinai Health System perks

Job summary

Mount Sinai Health System is seeking an Associate Vice President of Contract Compliance & Performance to lead enterprise governance, analytics, and performance management of payer contracts across hospitals, ambulatory sites, and faculty practice.

This leader will translate contract terms into operational requirements, establish maturity in contract compliance, and drive improvement across finance, IT, and clinical operations.

Qualifications

• Bachelor's degree in healthcare administration, finance, business administration, accounting, health information management, or a related field.
• Master's degree preferred (MBA, MHA, MPH, or related advanced degree).
• 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 ability to translate complex contractual and reimbursement requirements into operational processes, controls, analytics, and measurable outcomes.

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.
• Translate negotiated payer terms 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.
• Partner strategically with Managed Care leadership to ensure contract‑performance intelligence informs payer strategy and negotiations.
• 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 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.
• 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 escalation 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.
• Lead strategic leadership across enterprise for contract performance across Managed Care, Finance, Compliance, Legal, and Clinical leadership.

Skills

Healthcare finance

Payer contracting

Reimbursement analytics

Executive communication

Leadership

Strategic thinking

Change management

Data analytics

Cross-functional collab

Problem solving

Education

Bachelor's degree in healthcare administration/finance/business

Master's degree preferred (MBA/MHA/MPH)

Tools

Epic

Job description

Mount Sinai Health System is seeking an Associate Vice President of Contract Compliance & Performance to lead enterprise governance, analytics, and performance management of payer contracts across hospitals, ambulatory sites, and faculty practice.

This leader will translate contract terms into operational requirements, establish maturity in contract compliance, and drive improvement across finance, IT, and clinical operations.