Senior Director, Contract Compliance, and Performance

Mount Sinai Health System; New York (NY); On-site; USD 180,000 - 260,000; Full time

Job summary

Mount Sinai Health System seeks a Senior Director, Contract Compliance & Performance to lead the enterprise framework and drive value from payer contracts. You will guide operationalizing contract requirements and analytics across the organization.

You will coordinate with Managed Care, Revenue Cycle, IT, Finance, and clinical leadership, translating contracts into actionable requirements, dashboards, and controls to reduce risk and improve reimbursement.

Qualifications

• Bachelor's degree in healthcare administration, finance, business, accounting, health information management, data analytics, or related field.
• Master's degree preferred (MBA, MHA, MPH, or related).
• 7+ years in healthcare finance, payer contracting, reimbursement, revenue cycle or related field; 10+ years preferred.
• Experience in payer contract performance, reimbursement analytics, payment validation, or revenue-cycle analytics.
• Experience in large academic medical center or integrated health system.
• Experience with facility and professional reimbursement preferred.
• Ability to translate contractual and reimbursement requirements into operational processes and analytics.

Responsibilities

• Execute the enterprise Contract Compliance & Performance framework.
• Monitor payer contract compliance, reimbursement, obligations, and performance.
• Identify, quantify, and prioritize reimbursement variances.
• Translate contractual requirements into documented business, operational, and analytical requirements.
• Partner with Managed Care, Revenue Cycle, IT, Finance, and operational teams on contract implementation.
• Participate in contract configuration, testing, validation, and implementation activities.
• Validate that reimbursement methodologies, fee schedules, rates, escalators, and payment provisions are reflected in systems.
• Lead root-cause analysis of reimbursement discrepancies and drive corrective actions.
• Provide operational leadership for significant payer payment disputes and recovery opportunities.
• Support enterprise governance and risk monitoring for Contract Compliance & Performance.

Education

Bachelor's degree in healthcare administration, finance, business administration, accounting, health information management, data analytics, or a related field

Master's degree preferred (MBA, MHA, MPH, or related)

Job description

The Senior Director, Contract Compliance & Performance is a senior operational leader responsible for executing and advancing the enterprise Contract Compliance & Performance strategy under the direction of the Associate Vice President.

The position serves as a critical link between contractual requirements, reimbursement analytics, payment validation, operational controls, issue remediation, and executive intelligence.

The Senior Director does not replace the responsibilities or independent authority of Managed Care Contracting, Revenue Cycle Operations, Corporate Compliance, Legal, Finance, Internal Audit, or Clinical leadership. Rather, the role provides the operational leadership necessary to identify contract-performance issues, quantify their impact, coordinate cross-functional resolution, and ensure that corrective actions are implemented and sustained.

The Senior Director is expected to function as a strategic deputy and operational extension of the AVP, assuming responsibility for day-to-day execution of the Contract Compliance & Performance operating model while escalating material risks, strategic decisions, and enterprise-level issues to the AVP.

The role is accountable for ensuring that the organization's payer agreements are translated into measurable performance expectations and that material gaps between contracted economics and actual reimbursement are identified, investigated, remediated, and prevented from recurring.

Responsibilities:

Contract Compliance & Performance Operations: Execute the enterprise Contract Compliance & Performance framework established by the AVP.

• Implement standardized processes for monitoring payer contract compliance and performance.
• Monitor contractual reimbursement, payment accuracy, contractual obligations, and payer performance.
• Identify, quantify, and prioritize material reimbursement variances.
• Establish work plans for investigating and resolving identified contract-performance issues.

Contract Operationalization & Implementation: Support the AVP in ensuring negotiated payer agreements and amendments are accurately translated into operational and system requirements.

• Review payer contracts, amendments, rate changes, and reimbursement provisions for operational implications.
• Translate contractual requirements into documented business, operational, and analytical requirements.
• Partner with Managed Care, Revenue Cycle, IT, Finance, and operational teams on contract implementation.
• Participate in contract configuration, testing, validation, and implementation activities.
• Validate that reimbursement methodologies, fee schedules, rates, escalators, and payment provisions are appropriately reflected in applicable systems.

Reimbursement Analytics & Payment Validation: Lead operational execution of methodologies designed to determine whether payer reimbursement aligns with contractual expectations.

• Oversee development and execution of expected reimbursement methodologies.
• Identify underpayments, overpayments, payment variances, and other deviations from contractual expectations.
• Quantify financial impact associated with identified reimbursement discrepancies.
• Establish and maintain prioritization methodologies based on financial value, frequency, risk, payer significance, and operational impact.

Contract Performance Monitoring: Develop and maintain ongoing monitoring of payer contract performance.

Responsibilities include:

• Establish recurring monitoring schedules for high-value and high-risk contractual provisions.
• Develop payer-specific and contract-specific performance profiles.
• Identify emerging payment trends and areas of financial opportunity or risk.

Analytics, Reporting & Revenue Intelligence: Lead development and maintenance of operational reporting supporting Contract Compliance & Performance.

Reporting may include:

• Contracted versus actual reimbursement
• Payment accuracy

Responsibilities include:

• Establish and maintain standardized reporting methodologies.
• Partner with Revenue Reporting and Intelligence and Data & Analytics to ensure accurate and reliable data.

Root-Cause Analysis & Corrective Action: Lead structured investigation of material and recurring contract-performance issues.

• Conduct root-cause analysis of reimbursement discrepancies.
• Determine whether issues originate from contractual interpretation, payer behavior, billing, coding, system configuration, data, workflow, or other operational factors.

Appeals, Disputes & Recovery Support: Provide operational leadership and analytical support for significant payer payment disputes and recovery opportunities.

• Identify and prioritize payment recovery opportunities.
• Support development of documentation and analytical evidence for contractual disputes.

Managed Care & Payer Partnership: Support the AVP and Managed Care leadership with contract-performance intelligence.

• Provide payer-performance analysis to support contract negotiations and renewals.
• Prepare historical reimbursement and performance analyses.

Audit, Compliance & Risk Monitoring: Support the AVP in maintaining a risk-based contract compliance monitoring program.

• Conduct periodic reviews of high-risk or high-value contractual provisions.
• Execute monitoring activities in accordance with established compliance methodologies.

Technology, Systems & Data Management: Partner with IT, Revenue Cycle technology teams, Data & Analytics, and Revenue Reporting and Intelligence to support contract-performance capabilities.

• Define and document business requirements for contract-performance analytics and monitoring.
• Participate in system enhancement and technology roadmap initiatives.

Enterprise Governance & Process Management: Support the AVP in maintaining effective enterprise governance for Contract Compliance & Performance.

• Implement policies, procedures, standards, and controls established for the function.
• Maintain clear documentation of roles, responsibilities, decision rights, and escalation pathways.

Leadership & Organizational Management: Provide senior leadership for the operational teams supporting Contract Compliance & Performance.

• Lead and develop a high-performing multidisciplinary team.
• Establish team goals, priorities, performance expectations, and operating rhythms.

Qualifications:

• Bachelor's degree in healthcare administration, finance, business administration, accounting, health information management, data analytics, or a related field.
• Master's degree preferred, including MBA, MHA, MPH, or related advanced degree.
• 7 years of progressive experience in healthcare finance, payer contracting, reimbursement, revenue cycle, contract compliance, revenue analytics, or a related field. Strong preference for candidates with 10 or more years of experience
• Significant experience in payer contract performance, reimbursement analytics, payment validation, or revenue-cycle analytics.
• Experience working within a large academic medical center, integrated delivery network, multi-hospital health system, or similarly complex healthcare organization.
• Experience with both facility and professional reimbursement strongly preferred.
• Demonstrated experience leading complex analytical, operational, or enterprise initiatives.
• Experience partnering with Managed Care, Revenue Cycle, Finance, IT, Compliance, and operational leadership.
• Demonstrated ability to translate contractual and reimbursement requirements into operational processes, analytics, controls, and measurable outcomes.
• Experience leading teams of analysts, managers, or other professional staff.

Preferred Qualifications

• Experience within a major academic medical center or integrated academic health system.
• Experience with 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, payment validation, or reimbursement analytics technologies.
• Experience developing payer scorecards and executive dashboards.
• Experience with healthcare data warehouses and enterprise analytics platforms.
• Experience using automation, machine learning, or artificial intelligence in healthcare financial analytics.
• Experience with large-scale revenue-cycle transformation.
• Experience establishing enterprise governance and standardized processes.
• HFMA, healthcare finance, revenue-cycle, analytics, or project-management certification.

Certifications:

Relevant professional certifications may be preferred, including:

• HFMA Certified Revenue Cycle Representative (CRCR)
• Project Management Professional (PMP)
• Other relevant healthcare finance, reimbursement, compliance, analytics, or revenue-cycle certifications