Vice President, Payer & Government Relations

This is a fully remote position, open to applicants in Florida, +3 more states.

📋 Description

• Establish and nurture strategic partnerships with health plans and other payer affiliates

• Oversee the entire payer contract lifecycle to ensure sustainable reimbursement for PHS services

• Lead and facilitate payer contract negotiations, renewals, and strategic dialogues

• Track payer performance and pinpoint issues related to reimbursement, contracts, and operations

• Collaborate with Revenue Cycle and operational teams to address escalated payer concerns

• Assess payer requirements, reimbursement trends, and contractual modifications to evaluate their impact on PHS

• Advocate for reimbursement frameworks and payer policies that enhance access to pediatric home-based care

• Keep an eye on legislative, regulatory, and public policy shifts that may impact PHS, its employees, and the families served

• Analyze legislative and regulatory changes and interpret their business and operational implications

• Create and support advocacy strategies that promote PHS priorities

• Raise awareness and garner support for PHS services among policymakers, legislators, government bodies, and other stakeholders

• Act as a representative for PHS with trade associations, coalitions, state agencies, legislative committees, and external entities

• Forge relationships with individuals, groups, agencies, and officials that influence healthcare policy and reimbursement

• Engage in legislative and regulatory discussions advocating for care access for medically complex children

• Coordinate internal responses and strategies concerning emerging legislative and regulatory matters

• Serve as a subject-matter expert to executive leadership on payer, reimbursement, legislative, regulatory, and government affairs

• Prepare reports, recommendations, presentations, and executive communications concerning payer and government-relations initiatives

• Inform internal stakeholders about developments in payer, legislative, and regulatory matters

• Collect and analyze data to support payer negotiations, advocacy efforts, policy stances, and strategic decisions

• Simplify complex policy, regulatory, reimbursement, and contractual information into actionable recommendations

• Collaborate cross-functionally with Legal, Revenue Cycle, Finance, Operations, Clinical Services, and other departments

• Identify emerging risks and opportunities and proactively suggest strategies to leadership

• Represent PHS professionally with external stakeholders, industry partners, and public officials

• Exercise sound judgment and discretion in handling confidential and sensitive matters

⛳️ Requirements

• Bachelor’s degree is required; Master’s degree in Healthcare Administration, Business Administration, Finance, or a related field is preferred

• More than 10 years of progressive leadership experience in payer relations, managed care contracting, or healthcare revenue cycle

• Proven success in negotiating competitive reimbursement rates and complex contract structures

• Experience in developing national payer relationships and executing multi-market contracting strategies

• Comprehensive understanding of reimbursement methods, regulatory standards, and healthcare financial operations

• Demonstrated ability to create innovative payment arrangements that align with clinical outcomes and service complexities

• Strong analytical capabilities, negotiation skills, executive presence, and the ability to influence senior payer leadership

• Experience in government affairs, legislative advocacy, regulatory affairs, or healthcare public policy is preferred

• Familiarity with monitoring and analyzing proposed legislation, regulatory modifications, and healthcare policy, assessing their organizational impact is preferred

• Proven experience in building relationships with legislators, government agencies, health plans, trade associations, coalitions, and advocacy organizations is preferred

• Previous experience representing an organization before policymakers, government agencies, industry associations, or other external stakeholders is preferred

• Experience collaborating with Revenue Cycle, Finance, Legal, and operational teams to tackle complex reimbursement, denial, authorization, contractual, or payer issues is preferred

• History of working across multiple states and navigating diverse payer, Medicaid, legislative, and regulatory environments is preferred

• Relevant experience within home health, DME, pediatric healthcare, specialty pharmacy, infusion, private duty nursing, or other home- and community-based healthcare services is preferred

• Proficiency in utilizing financial, reimbursement, utilization, clinical, or operational data to support payer negotiations and advocacy efforts is preferred

• Experience in developing or supporting alternative, value-based, or other innovative payment arrangements is preferred

• Background in educating executive leadership and internal stakeholders about payer, legislative, regulatory, and reimbursement developments is preferred

• Master’s degree in Public Policy, Public Administration, Healthcare Administration, Business Administration, Finance, or a related field is preferred

🏝️ Benefits

• Generous Paid Time Off (PTO) for full-time employees to promote a healthy work-life balance

• 401(k) Matching to help ensure your financial future

• Tuition Reimbursement to support your educational and professional development

• Opportunities for Professional Development & Learning to enhance your skills and knowledge in pediatric care

• Comprehensive Health and Dental insurance

• Short & Long Term Disability and Life Insurance