Job Description

The Senior Manager, Pharmacy Services Revenue Integrity develops and manages the people, tools/technologies and processes required to manage and improve financial performance of pharmacy services across the MSHS system through various activities including reimbursement and cost analytics, settlement reconciliation, and charge master maintenance and optimization. This position is responsible for partnering across the system to bring together the administrative, financial, and operational resources and insight necessary to timely and accurately evaluate third party payor contract performance including reimbursement rates, direct and indirect remuneration (DIR) take-backs, and administrative and quality-based performance outcomes. This position continuously identifies and leverages new technologies to improve quantitative and qualitative processes and analytical tools aimed at tracking and optimizing financial performance. Additionally, the position contributes directly to the development of an external revenue stream by creating and packaging scalable revenue integrity services and tools that support health system-based pharmacy operations.

The position develops and directs the analytical techniques and tools used to monitor and report on reimbursement and related financial metrics.

Qualifications

• Doctor of Pharmacy Required.

• MBA or JD preferred.

• 10+ years of related pharmacy experience with special consideration given to pharmacy contract valuations, pharmacy services financial analysis, healthcare reimbursement and payment methodologies and pharmacy site operations required.

• 3+ years’ experience managing and leading a team required.

• 10+ years of related experience with special consideration given to specific knowledge of payor and provider organizations and knowledge of state and federal health care programs.

• Expert in Microsoft Tools (e.g. Excel, Word, PowerPoint etc.) preferred.

• Registered Pharmacist or Pharmacy License.

Non-Bargaining Unit, 600 - HSO Pharmacy - MSH, Mount Sinai Hospital

Responsibilities

I. Payment Accuracy

• Direct analysis of payment accuracy against contractual rates to identify discrepancies.

• Develop, maintain, and implement best practices to ensure charge levels optimize third party payer reimbursement.

• Identify, leverage, and manage technology systems to improve processes, track reimbursement performance and payment accuracy.

• Lead communications with external payers on payment discrepancies, while informing key leaders of results, and collaborating with other departments as needed for.

• Maintain in-depth knowledge of PBM contracts, Medicaid/Medicare services and reimbursement methodologies across all sites of care.

• Develop, manage, and maintain a systematic transparent revenue integrity payment audit process, including tracking tools, metrics, and reporting

II. Contract Negotiation Valuations

• Provide Contract leaders with payer reimbursement updates, market changes and trends

• Track and evaluate business movement conversions and communicate results to leadership.

• Provide advanced analytics on trends, benchmarks, and performance measures that identify areas that provide revenue enhancement opportunities

• Use pharmacy revenue integrity metrics and standardized operating procedures to analyze proposed contracts addendums and product lines for financial impact.

• Develop and maintain crosswalks for various payment methodologies including, AWP, WAC, and ASP.

III. Financial Performance

• Perform financial evaluations including measuring the impact of administrative and clinical performance-based criteria on takeback amounts.

• Provides continuous education and subject matter expertise to leadership across the delivery system to help identify areas of focus and strategic direction.

• Responsible for the integrity and accuracy of financial documentation that supports pharmacy services optimization across the organization.

• Partner with operations leadership to ensure the administrative and clinical performance measurements are achievable.

• Manage the process to track performance of all pharmacy services related payer contracts.

IV. Charge Optimization

• Develop and manage the processes, tools, and procedures to analyze charge levels against third party payer contract rates.

• Work closely with operations to ensure accuracy and consistency/standardization when setting charges.

• Lead charge optimization analytics to support financial performance.

V. Business Operations Support

• Develop and maintain standardized processes to identify and track top contracts, top lines of business and payer mix.

• Continuously develop processes and tools to enhance revenue that leads to new products and services.

• Create new analytical models and intellectual property that helps the revenue integrity team differentiate itself in the marketplace when it comes to leading new products and services.

• Maintain up to date technical knowledge through educational workshops, user groups and reviewing publications.

• Report pharmacy services related metric to leaders.

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.

Compensation Statement

Mount Sinai Health System (MSHS) provides a salary range to comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $127044 - $190565 Annually. Actual salaries depend on a variety of factors, including experience, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.