Vice President, Payer Relations

This is a fully remote position, open to applicants in Florida.

📋 Description

• Formulate and implement the organization's payer-relations strategy across ophthalmology practices, ambulatory surgery centers, and associated services.

• Provide counsel to executive leadership regarding payer trends, reimbursement risks, contracting opportunities, and market changes.

• Oversee negotiations for commercial, Medicare Advantage, managed Medicaid, and various payer agreements.

• Assess contract terms, reimbursement methodologies, fee schedules, payment policies, network requirements, and administrative clauses.

• Track contract terms, renewal dates, amendments, notice periods, and essential obligations.

• Develop and sustain relationships with payer executives, provider-relations representatives, contracting teams, and medical-management leaders.

• Act as an escalation point for payer-related issues impacting reimbursement, patient access, claims processing, prior authorization, and provider participation.

• Analyze reimbursement trends, payer performance, denials, payment accuracy, and contract adherence.

• Examine reimbursement by payer, service line, provider, location, and procedure category.

• Identify underpayments, payment discrepancies, and systemic reimbursement challenges.

• Evaluate opportunities for network participation and assist with payer enrollment and participation documentation.

• Collaborate with Revenue Cycle, Finance, Operations, Credentialing, Compliance, Legal, Clinical Leadership, and Information Technology teams.

• Aid in due diligence and integration planning for acquisitions and new market entry.

• Stay informed about healthcare reimbursement, managed-care, and regulatory changes.

• Lead, mentor, and support payer-relations team members and assigned staff.

• Set goals, performance metrics, workflows, and accountability standards.

• Conduct interviews, hire, train, assign tasks, direct, and evaluate employees while addressing staff concerns and issues.

⛳️ Requirements

• A bachelor’s degree in healthcare administration, business administration, finance, economics, or a related discipline is required.

• At least eight years of progressive experience in payer relations, managed-care contracting, reimbursement strategy, healthcare finance, revenue cycle, or a similar field.

• Proven capability to interpret complex contract language, fee schedules, reimbursement methodologies, and payer policies.

• Advanced understanding of payer contracting, managed-care principles, reimbursement frameworks, and healthcare financial analysis.

• Exceptional negotiation skills.

• Competence in evaluating complex data and translating insights into actionable business recommendations.

• Strong executive presence coupled with excellent communication skills.

• Superior judgment, analytical thinking, and problem-solving abilities.

• Capability to manage multiple priorities, deadlines, and negotiations in a dynamic healthcare setting.

• Strong written, verbal, and presentation skills.

• High level of professionalism, discretion, and integrity in handling confidential financial and contractual information.

• Proficiency in Microsoft Office applications and contract-management, reporting, and analytics tools.

• Travel is necessary.

• Ability to meet the physical demands of the role, including walking, standing, bending, stooping, and lifting up to 10 pounds.

🏝️ Benefits

• Full-time salaried position.

• Monday through Friday, 8:00 A.M.–5:00 P.M.

• Reasonable accommodations may be provided to individuals with disabilities.