Vice President, Payor Relations

SUN BEHAVIORAL HEALTH GROUP•Houston, TX

2d•Onsite

About The Position

The Vice President Payor Relations is responsible for developing and executing enterprise-wide payer strategy across all hospital and outpatient service lines. This role leads contract negotiations, reimbursement optimization, and value-based initiatives with commercial payers, Medicaid MCOs, Medicare Advantage plans, and government programs. The VP serves as the primary executive liaison between the organization and payers, ensuring competitive reimbursement and alignment with quality and utilization outcomes.

Requirements

10 years in healthcare payor relations with strong experience in managed behavioral health or psychiatric hospitals.
Knowledge of Medicaid MCO contracting, IMD reimbursement structures, and Medicare and commercial contracting.
Bachelors degree

Nice To Haves

MBA or MHA
Previous experience with psychiatric hospital systems (IMD and outpatient continuum), state directed payment programs (SDPs, HRIP, CHIRP, ATLIS), PHP/IOP reimbursement strategy, and HCBS contracting
May substitute education for experience

Responsibilities

Develop and execute a national payer strategy across all facilities (IP, PHP, IOP, HCBS, ECT)
Lead negotiation of inpatient per diem rates, outpatient hospital rates (PHP/IOP, HCBS), special therapies (e.g., ECT, 1-1 services), and value-based/shared savings arrangements/risk-based
Standardize contracting approach across states while adapting to Medicaid fee-for-service and Medicaid Managed Care contracting and state directed payment programs (SDPs)
Drive optimization of reimbursement in Medicaid MCO contracts, Medicare Advantage contracts and other state and federal contracts
Lead the response to RFPs for grant-related contracts, LMHA and CMHC contracts, provider-based relations (CMS 855), and SAM.gov applications and updates
Partner with finance and policy teams to identify rate inequities and unmet service needs
Partner with finance and policy teams to support legislative and regulatory advocacy through national, state and local trade associations and advocacy groups
Ensure compliance with CMS rules (Hospital Rate Transparency, parity, IMD exclusion, etc.), state-specific reimbursement methodologies, and LMHA and CMHC contract requirements
Support payer-related revenue performance, including net revenue per adjusted patient day and LOS optimization strategies
Assist the revenue cycle team to analyze denials, underpayments, and contractual requirements, as well as variance between contracted vs paid rates
Advise on initiatives to improve yield per patient, rate proposal development
Ensure facilities maintain in-network status with key payers
Support expansion into new markets by securing contracts for new facilities and service lines, and negotiating go-live rates and interim agreements
Position organization as high-quality behavioral health partner and solution for ED boarding, readmissions, continuum services and access gaps
Develop payor partnerships tied to reduced readmissions (7-day / 30-day, all cause readmissions), ED diversion and LOS management, HEDIS measures (e.g., FUH, IET, FUM) and reduction in total cost of care
Structure bundled payments, case rates, and risk-based or shared savings models
Align clinical programs (PHP step-down, HCBS integration) with payer priorities
Collaborate with revenue cycle team on billing, collections, denials
Collaborate with clinical leadership (Intake, UM, PI/Risk, HIM, Medical Staff, Nursing)
Collaborate with Business Development (new programs, expansion of existing services, satellite OP, integration with HCBS)
Collaborate with Health Information Exchange (HIE) participation with IT and HIM
Provide payer insights into supporting program design (e.g., PHP with boarding), HCBS integration, improving authorization and utilization management processes, and managed care driven policy changes (e.g., ASAM Criteria 4.0, revenue code changes)
Lead and develop a team of facility-based stakeholders (CEO, CFO, Business Office Directors, Directors of Utilization Management, Clinical Directors) for contract compliance monitoring
Establish KPIs for contract execution timelines, rate improvement targets and payer performance scorecards
Perform other duties as assigned.
Strives to create a safe, healing environment for patients and family members
Follows all safety rules while on the job. Reports “near misses”, as well as errors and accidents promptly. Corrects minor safety hazards. Communicates with peers and management regarding any hazards identified in the workplace. Attends all required safety programs and understands responsibilities related to general, department, and job specific safety. Participates in quality projects, as assigned, and supports quality initiatives. Supports and maintains a culture of safety and quality.
Works well with others in a spirit of teamwork and cooperation. Responds willingly to colleagues and serves as an active part of the hospital team. Builds collaborative relationships with patients, families, staff, and physicians. The ability to retrieve, communicate, and present data and information both verbally and in writing as required Demonstrates listening skills and the ability to express or exchange ideas by means of the spoken and written word. Demonstrates adequate skills in all forms of communication. Adheres to the Standards of Behavior
Strives to always do the right thing for the patient, coworkers, and the hospital
Adheres to established standards, policies, procedures, protocols, and laws. Applies the Mission and Values of SUN Behavioral Health to personal practice and commits to service excellence. Supports and demonstrates fiscal responsibility through supply usage, ordering of supplies, and conservation of facility resources. Completes required trainings within defined time periods, as established by job description, policies, or hospital leadership Exemplifies professionalism through good attendance and positive attitude, at all times. Maintains confidentiality of patient and staff information, following HIPAA and other privacy laws. Ensures proper documentation in all position activities, following federal and state guidelines.
Demonstrates accountability for ensuring the highest quality patient care for patients. Willingness to be accepting of those in need, and to extend a helping hand Desire to go above and beyond for others Understanding and accepting of cultural diversity and differences