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 organizations.

• Oversee the lifecycle of payer contracts to ensure sustainable reimbursement for PHS services.

• Lead and facilitate negotiations, renewals, and strategic discussions regarding payer contracts.

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

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

• Examine payer requirements, reimbursement trends, and contractual modifications, assessing their implications for PHS.

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

• Keep abreast of legislation, regulations, and public policy changes that impact PHS, its employees, and the children and families it serves.

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

• Develop and implement advocacy strategies that advance PHS priorities.

• Raise awareness and support for PHS services among policymakers, legislators, government agencies, and other stakeholders.

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

• Cultivate relationships with individuals, groups, agencies, and officials who influence healthcare policy and reimbursement.

• Engage in legislative and regulatory discussions and advocate for policies that facilitate access to care.

• Coordinate internal responses and strategies concerning emerging legislative and regulatory challenges.

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

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

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

• Collect and analyze data to support payer negotiations, advocacy initiatives, policy positions, and strategic decisions.

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

• Collaborate with Legal, Revenue Cycle, Finance, Operations, Clinical Services, and other teams.

• Identify emerging risks and opportunities, offering strategic recommendations to leadership.

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

• Apply sound judgment and discretion when handling confidential and sensitive matters.

⛳️ Requirements

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

• 10+ years of progressive leadership experience in payer relations, managed care contracting, or healthcare revenue cycle management.

• Proven track record of negotiating competitive reimbursement rates and complex contract arrangements.

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

• In-depth knowledge of reimbursement methodologies, regulatory standards, and healthcare financial operations.

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

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

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

• Background in monitoring and analyzing proposed legislation, regulatory changes, and healthcare policy with an emphasis on organizational impact is preferred.

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

• Proven experience representing an organization to policymakers, government bodies, industry associations, or other external stakeholders is preferred.

• Experience working alongside Revenue Cycle, Finance, Legal, and operational teams to resolve complex reimbursement, denial, authorization, contractual, or payer issues is preferred.

• Experience navigating various payer, Medicaid, legislative, and regulatory environments across multiple states is preferred.

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

• Familiarity with financial, reimbursement, utilization, clinical, or operational data to support payer negotiations and advocacy initiatives is preferred.

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

• Experience educating executive leadership and internal stakeholders on payer, legislative, regulatory, and reimbursement developments is preferred.

• A 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 assist in securing your financial future.

• Tuition Reimbursement to facilitate 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.