The Director Health System Authorization is for the Mount Sinai Health System (MSHS) and the Icahn School of Medicine at Mount Sinai (ISMMS) (which includes the MSHS and the Faculty Practice Plan) is accountable for authorization across the medical center. The Director will report to the Senior Director Financial Clearance of the MSHS.
The Director of Authorization is a key leader within the Revenue Cycle Management team, responsible for overseeing all aspects of authorization across the healthcare system. This includes inpatient, outpatient, professional and ambulatory care settings. The director is charged with ensuring accurate and timely patient authorization, and insurance data collection, compliance with regulatory requirements, and front-end revenue integrity. The role plays a critical part in driving operational excellence, enhancing the patient experience, and supporting the financial health of the organization.
Direct daily operations of the patient authorization function for hospital, ambulatory care, and practice settings.
Ensure authorization workflows align with revenue cycle best practices to reduce claim denials, improve cash collections, and enhance clean claim rates.
Develop and implement policies and procedures that promote efficiency, data integrity, and regulatory compliance (e.g., HIPAA, CMS).
Monitor key performance indicators (KPIs) such as authorization accuracy, turnaround times, and patient scheduling delays due to pending authorizations; analyze trends and initiate performance improvement plans as needed.
Collaborate with departments such as billing, coding, IT, clinical operations, and compliance to ensure a seamless authorization process that expedites patient care.
Lead, coach, and mentor a team of managers, supervisors, and front-line authorization staff; oversee training, performance evaluations, and staff development.
Maintain strong internal controls and audit readiness for all authorization-related processes.
Support organizational goals related to patient satisfaction, clinical efficiency, and access to care.
Utilize revenue cycle and EHR systems effectively.
Organize routine meetings with health system business leaders and managed care teams to review authorization performance, payer issues, and denials.
Build effective, collaborative relationships with key stakeholders across departments (e.g., DTP, Human Performance, Managed Care, Finance, and clinical departments).
Collaborate with Finance, Managed Care, and DTP contributors to develop and operationalize optimal authorization performance and trending.
Provide leadership and support governance processes to ensure effective, efficient, standardized, and compliant practices across MSHS.
Investigate and resolve denials; coordinate efforts to assist senior revenue cycle leaders in developing innovative strategies and solutions.
Work closely with clinical leaders and department administrators to provide education, industry best practices, and recommendations on authorization and insurance verification.
Establish and maintain strong working relationships with Revenue Cycle leaders, hospital and department leaders, and key strategic partners.
Maintain a strong understanding of revenue performance metrics and payer mix; lead the team in building plans to support operational departments in achieving best practice performance through analytics, process improvement, and technology enhancements.
Maintain strong customer relationships with key strategic partners.
Ensure appropriate functional strategic partners are engaged throughout the process.
Monitor and provide regular reporting to senior management on key performance metrics (e.g., actual vs. expected results for financial targets).
Bring developing issues and recommended actions to the attention of senior leadership and governance committees.
Develop, maintain, and ensure compliance with standardized policies, processes, and programs across MSHS.
Develop a high-performing team, measured by benchmark process outcomes, audit and compliance results, financial goals, and employee satisfaction.
Stay current with government regulations regarding patient access, authorization, and insurance.
Establish goals, objectives, and budgets for assigned areas; monitor and manage to ensure achievement once approved.
Ensure all HIPAA privacy and security standards are adhered to.
Conform to established policies, procedures, processes, and Standards of Behavior; ensure assigned staff do the same.
Perform other duties as assigned.
Education
Experience
Working Conditions: Corporate office environment in an academic health system.
518 - PFS 633 Third Avenue - MSH, Mount Sinai Hospital
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/