Vice President, Payer & Government Relations

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

📋 Description

• Enhance PHS's relationships with payers, reimbursement strategies, government affairs, and public policy objectives.

• Establish and nurture strategic partnerships with health plans and payer collaborators.

• Oversee the payer contract lifecycle, leading negotiations, renewals, and strategic discussions.

• Track payer performance and pinpoint reimbursement, contractual, and operational challenges.

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

• Evaluate payer requirements, reimbursement trends, and contractual modifications, assessing their impact on PHS.

• Advocate for reimbursement frameworks and payer policies that support pediatric home-based care.

• Stay updated on legislation, regulations, and public policy changes affecting PHS, its employees, and medically complex children and families.

• Formulate and execute advocacy strategies, garnering support for PHS services from policymakers and stakeholders.

• Represent PHS in trade associations, coalitions, state agencies, legislative committees, and other external organizations.

• Cultivate relationships with officials and organizations that influence healthcare policy and reimbursement.

• Coordinate internal responses to emerging legislative and regulatory matters.

• Provide counsel to executive leadership on payer, reimbursement, legislative, regulatory, and government affairs issues.

• Prepare reports, recommendations, presentations, and communications for executives.

• Educate internal stakeholders on developments related to payers, legislation, and regulation.

• Collect and analyze data to support negotiations, advocacy efforts, policy positions, and strategic choices.

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

• Collaborate across functions with Legal, Revenue Cycle, Finance, Operations, and Clinical Services.

• Identify emerging risks and opportunities, recommending strategies to leadership.

• Professionally represent PHS with external stakeholders, industry partners, and public officials.

• Exercise discretion and judgment when handling confidential and sensitive issues.

⛳️ Requirements

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

• Over 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.

• In-depth understanding of reimbursement methodologies, regulatory requirements, and healthcare financial operations.

• Demonstrated ability to craft innovative payment arrangements aligned with clinical outcomes and service complexity.

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

• Preferred experience in government affairs, legislative advocacy, regulatory affairs, or healthcare public policy.

• Preferred experience in monitoring and analyzing proposed legislation, regulatory changes, and healthcare policy, assessing their potential impact on the organization.

• Preferred experience in building relationships with legislators, government agencies, health plans, trade associations, coalitions, and advocacy organizations.

• Preferred experience in representing an organization before policymakers, government agencies, industry associations, or other external stakeholders.

• Preferred experience in partnering with Revenue Cycle, Finance, Legal, and operational teams to resolve complex reimbursement, denial, authorization, contractual, or payer issues.

• Preferred experience working across multiple states and navigating various payer, Medicaid, legislative, and regulatory environments.

• Preferred experience in home health, DME, pediatric healthcare, specialty pharmacy, infusion, private duty nursing, or other home- and community-based healthcare services.

• Preferred experience using financial, reimbursement, utilization, clinical, or operational data to bolster payer negotiations and advocacy initiatives.

• Preferred experience in developing or supporting alternative, value-based, or other innovative payment arrangements.

• Preferred experience in educating executive leadership and internal stakeholders on payer, legislative, regulatory, and reimbursement developments.

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

🏝️ Benefits

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

• 401(k) Matching to help secure your financial future.

• Tuition Reimbursement to facilitate your educational and professional development.

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

• Comprehensive Health and Dental insurance.

• Short & Long Term Disability and Life Insurance.