Associate Vice President, Contract Compliance & Performance

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JOB DESCRIPTION

Position Summary

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.

ABOUT US

Strength through Unity and Inclusion

The Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai’s unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. We encourage all team members to actively participate in creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual.

At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally. Explore this opportunity and be part of the next chapter in our history.

About the Mount Sinai Health System:

Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes more than 9,000 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 11 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.

Equal Opportunity Employer

The Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. We are deeply committed to fostering an environment where all faculty, staff, students, trainees, patients, visitors, and the communities we serve feel respected and supported. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization.

RESPONSIBILITIES

Essential Responsibilities

1. Enterprise Contract Compliance & Performance

• 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.

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2. Contract Operationalization

Provide enterprise oversight for translating negotiated payer agreements, amendments, and reimbursement methodologies into operational and system requirements.

Responsibilities include:

• 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.

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3. Reimbursement Performance & Payment Validation

Lead enterprise efforts to determine whether actual payer reimbursement aligns with contractual expectations.

Responsibilities include:

• 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.

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4. Managed Care Partnership

Partner strategically with Managed Care leadership to ensure contract-performance intelligence informs payer strategy and negotiations.

Responsibilities include:

• 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.

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5. Analytics & Revenue Intelligence

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

Responsibilities include:

• 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.

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6. Audit, Compliance & Risk Management

Establish a risk-based framework for monitoring compliance with payer contractual obligations and applicable reimbursement requirements.

Responsibilities include:

• 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.

The AVP will work in partnership with, but will not replace, the independent authority of Corporate Compliance, Legal, Internal Audit, or other designated oversight functions.

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7. Appeals, Disputes & Recovery

Provide executive oversight for significant payer payment disputes and recovery activities.

Responsibilities include:

• 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.

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8. Technology, Data & Systems

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

Responsibilities include:

• 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.

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9. Enterprise Governance

Establish and maintain governance structures that support consistent enterprise management of contract compliance and performance.

Responsibilities include:

• 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.

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10. Leadership

Reporting to the Vice President of Revenue Reporting and Intelligence, provide strategic leadership for the Contract Compliance & Performance function.

Responsibilities include:

• 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 perfor....