Job Description

Director, Professional Billing Revenue Reporting, Recognition, Reimbursement & Analytics-Financial Administration-Corporate 42nd Street-Hybrid

The Director, Professional Billing Revenue Reporting, Recognition, Reimbursement & Analytics for the Icahn School of Medicine at Mount Sinai (ISMMS) and the Mount Sinai Faculty Practice (MSFP) provides leadership for revenue recognition, revenue reporting, reimbursement analysis, accounts receivable performance, cash realization, provider productivity analytics, working capital analytics, and professional revenue cycle financial performance.

Reporting to the Senior Director of Revenue, the Director is responsible for establishing and maintaining a comprehensive framework for professional revenue reporting, reimbursement analytics, financial reporting, accounts receivable oversight, and performance management. The position serves as Finance's primary leader for professional revenue recognition compliance, physician revenue reporting, reimbursement analysis, accounts receivable performance, cash collections analytics, provider revenue performance measurement, and financial forecasting.

This role ensures compliance with U.S. GAAP, ASC 606, applicable healthcare regulatory requirements, and physician billing regulations while providing independent financial oversight of the Faculty Practice Plan's professional revenue portfolio. The Director transforms operational, reimbursement, provider, and financial data into actionable business intelligence that supports executive decision-making, strengthens revenue integrity, improves liquidity and cash flow performance, enhances financial forecasting, and drives sustainable financial performance.

Working collaboratively with Faculty Practice leadership, Professional Billing Operations, Revenue Cycle, Reimbursement, Managed Care Contracting, Financial Planning, Department Administrators, Accounting, Compliance, Internal Audit, and physician leadership, this position develops standardized reporting, establishes governance and controls, identifies financial risks and opportunities, and drives continuous process improvement across the professional billing enterprise.

Responsibilities

Revenue Recognition, ASC 606 Governance & Financial Reporting
1. Serve as the organizational leader for professional revenue recognition governance, ensuring compliance with U.S. GAAP, ASC 606, healthcare regulatory requirements, and organizational policies.
2. Oversee professional revenue recognition processes and ensure consistent application of revenue recognition methodologies across physician and faculty practice revenue streams.
3. Develop, implement, and maintain revenue recognition policies, procedures, controls, and documentation supporting ASC 606 compliance.
4. Evaluate significant accounting estimates and judgments affecting professional revenue, including contractual allowances, implicit price concessions, settlements, third-party reimbursement adjustments, and other revenue valuation methodologies.
5. Direct the preparation, review, and presentation of professional revenue-related financial reporting, analyses, disclosures, and executive summaries.
6. Establish and maintain standardized reporting methodologies and definitions across ISMMS and the Faculty Practice Plan to ensure consistency and transparency.
7. Partner with Accounting and Finance leadership to support month-end, quarter-end, and year-end close processes related to professional revenue reporting and revenue recognition.
8. Collaborate with internal and external auditors to support financial statement audits, revenue-related reviews, compliance assessments, and accounting documentation.
9. Assess the revenue recognition implications of operational, reimbursement, contractual, regulatory, provider compensation, and strategic business changes.
10. Ensure accurate and timely preparation of revenue-related financial statement disclosures and supporting documentation.

Professional Revenue Analytics, Accounts Receivable & Reimbursement Performance
1. Lead the development and maintenance of enterprise professional billing accounts receivable reporting.
2. Monitor and analyze accounts receivable performance by department, specialty, physician group, provider, location, payer, and financial class.
3. Evaluate trends affecting collections, aging, charge lag, denials, reimbursement, payment velocity, cash realization, and working capital performance.
4. Assess payer payment patterns, underpayments, reimbursement delays, contractual variances, and collection effectiveness.
5. Identify emerging financial risks and opportunities affecting revenue recognition, revenue realization, collections, liquidity, and overall financial performance.
6. Support initiatives to reduce denials, improve clean claim rates, accelerate reimbursement, strengthen payer performance, and optimize cash collections.
7. Partner with Professional Billing and Revenue Cycle leadership to improve financial performance while maintaining independent financial oversight responsibilities.
8. Analyze managed care contracts, reimbursement arrangements, and payment methodologies affecting professional services to assess financial impact, revenue implications, reimbursement trends, and financial risk.
9. Monitor reimbursement performance by payer, contract, specialty, department, provider, and payment methodology to identify opportunities for revenue enhancement and operational improvement.
10. Evaluate payer compliance with contractual terms and identify reimbursement variances, underpayments, payment integrity concerns, and collection opportunities.
11. Demonstrate strong knowledge of major reimbursement methodologies affecting professional billing, including managed care, commercial, Medicare, Medicaid, and other payer arrangements.
12. Understand and analyze the key terms and financial provisions of managed care contracts affecting professional reimbursement, including fee schedules, physician compensation impacts, RVU-based payments, bundled payments, value-based arrangements, incentives, and other payment methodologies.
13. Develop reporting and analytics that assess reimbursement performance and support organizational revenue optimization initiatives.
14. Analyze provider productivity, charge capture, coding utilization, reimbursement trends, and physician financial performance metrics.

Financial Planning, Forecasting & Performance Management
1. Develop professional revenue forecasts and financial performance projections utilizing historical trends, reimbursement analyses, operational drivers, physician productivity trends, and ASC 606 revenue recognition assumptions.
2. Support enterprise cash forecasting through comprehensive analysis of accounts receivable performance, collection trends, reimbursement patterns, and revenue realization.
3. Perform financial modeling to assess the impact of operational, provider, payer, reimbursement, contractual, compensation, and regulatory changes on revenue, cash flow, and liquidity.
4. Establish, monitor, and continuously enhance key performance indicators (KPIs) related to revenue recognition, financial reporting, accounts receivable, collections, reimbursement performance, provider productivity, and revenue cycle effectiveness.
5. Produce recurring executive dashboards, scorecards, analytics packages, and performance reports for senior leadership, department chairs, Faculty Practice leadership, and governance committees.
6. Analyze actual versus expected performance and provide actionable insights to improve financial and operational results.
7. Develop revenue trend analyses and benchmarking reports to support strategic planning and organizational decision-making.
8. Monitor and interpret government reimbursement methodologies and regulatory changes affecting professional revenue streams and assess implications for reimbursement performance, revenue recognition, financial reporting, forecasting, and cash flow.
9. Evaluate proposed changes to Medicare Physician Fee Schedule, Medicaid reimbursement methodologies, managed care reimbursement arrangements, and commercial payer contracts and quantify projected financial impacts.
10. Incorporate reimbursement assumptions, payer-specific trends, contractual provisions, regulatory developments, provider productivity trends, and payment methodology changes into forecasting models and long-range revenue projections.
11. Support budgeting, forecasting, compensation planning, and long-range strategic planning initiatives through advanced reimbursement and revenue analytics.

Strategic Leadership & Business Partnership
1. Identify financial risks, opportunities, and emerging trends impacting professional revenue performance, reimbursement, collections, productivity, and financial sustainability.
2. Collaborate with Faculty Practice leadership, Managed Care, Revenue Cycle, Reimbursement, Financial Planning, Compliance, Accounting, Department Administrators, and physician leadership to identify revenue optimization opportunities.
3. Investigate revenue shortfalls, payment variances, underpayments, productivity trends, and other performance concerns and develop recommendations for corrective action.
4. Promote standardization, automation, and continuous improvement of reporting, analytics, forecasting, reimbursement analysis, and governance processes.
5. Create feedback mechanisms and performance measurement frameworks that support sustainable organizational improvement.
6. Provide leadership and support governance processes that facilitate effective, efficient, standardized, compliant, and transparent practices.
7. Challenge existing assumptions and operational practices to facilitate informed decision-making and balanced evaluation of risks and opportunities.
8. Present complex financial analyses and recommendations to executive leadership, physician leaders, department chairs, and operational stakeholders.
9. Demonstrate comprehensive knowledge of reimbursement methodologies applicable to professional services, including managed care, commercial, Medicare, Medicaid, alternative payment models, bundled payments, capitation, and value-based reimbursement arrangements.
10. Understand and evaluate key financial provisions within managed care contracts impacting physician services, including fee schedules, reimbursement rates, risk arrangements, quality incentives, and alternative payment models.
11. Monitor government reimbursement methodologies, payer policies, industry developments, and regulatory changes affecting professional revenue recognition, reimbursement performance, financial reporting, and organizational financial results.
12. Evaluate proposed reimbursement policy changes and assess their potential financial impact on physician and faculty practice revenue.
13. Partner with Finance, Reimbursement, Managed Care Contracting, Professional Billing, Revenue Cycle, and operational leadership to translate reimbursement requirements, payment methodologies, and contract provisions into actionable revenue analytics, reporting, forecasting, and strategic recommendations.
14. Support contract modeling, reimbursement analysis, provider compensation analysis, and strategic initiatives designed to improve reimbursement performance, mitigate financial risk, and strengthen long-term financial sustainability.

Team Leadership
1. Lead, mentor, and develop a high-performing team of finance, accounting, analytics, and reporting professionals.
2. Foster a culture of accountability, innovation, collaboration, and continuous improvement.
3. Establish clear performance expectations and support professional growth and development.
4. Build and maintain effective relationships with executive leadership, operational leaders, and key stakeholders throughout the organization.
5. Influence strategic decisions through effective communication of financial concepts, analytical findings, and performance insights.
Compliance & Other Responsibilities
1. Ensure compliance with all HIPAA privacy and security requirements.
2. Ensure compliance with physician billing regulations, documentation requirements, and applicable federal and state reimbursement regulations.
3. Support internal and external audits related to professional revenue reporting, reimbursement, revenue recognition, and financial performance.
4. Adhere to all organizational policies, procedures, and Standards of Behavior.
5. Perform other duties as assigned by Revenue leadership.

ESSENTIAL FUNCTIONS OF POSITION:
1. Ability to perform duties and responsibilities independently with minimal supervision.
2. Ability to evaluate complex financial, operational, reimbursement, physician practice, and accounting matters and make sound business decisions.
3. Ability to objectively assess organizational, operational, and staff performance and implement effective improvement strategies.
4. Ability to prioritize multiple initiatives in a rapidly changing environment while maintaining high-quality outcomes.
5. Ability to lead organizational change and implement new processes, technologies, and governance frameworks.
6. Ability to effectively communicate complex accounting, financial, reimbursement, and operational information to executive, physician, and non-financial audiences.
7. Ability to evaluate reimbursement methodologies, contractual arrangements, regulatory developments, provider productivity trends, and financial implications impacting organizational performance.

MINIMUM KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:
1. Expert knowledge of U.S. GAAP and ASC 606 Revenue from Contracts with Customers, including application within complex healthcare organizations.
2. Extensive understanding of physician reimbursement methodologies, professional revenue accounting, contractual allowances, implicit price concessions, reserve analysis, and revenue valuation processes.
3. Strong understanding of professional billing revenue cycle operations, accounts receivable management, collections, denials, reimbursement trends, payer performance, and working capital analytics.
4. Demonstrated experience developing revenue recognition policies, governance frameworks, internal controls, and enterprise reporting methodologies.
5. Advanced analytical, financial modeling, forecasting, and problem-solving capabilities.
6. Strong financial management skills, including budgeting, forecasting, auditing, accounting, reporting, and operational analytics.
7. Abil