VP, Payer Relations

US Eye•Remote, FL, FL

2d•Hybrid

About The Position

The Vice President of Payer Relations is responsible for developing and leading the organization’s payer strategy across its ophthalmology practices, ambulatory surgery centers, and affiliated services. This executive role oversees payer contracting, reimbursement analysis, network participation, relationship management, and issue resolution to support sustainable growth and appropriate payment for the services provided. The Vice President of Payer Relations serves as the organization’s primary strategic liaison with commercial health plans, Medicare Advantage plans, managed Medicaid plans, and other payer partners. Working closely with executive leadership, Finance, Revenue Cycle, Operations, Credentialing, and physician leaders, this role translates complex payer dynamics into clear business strategies and practical action plans.

Requirements

Demonstrated ability to follow oral and written instructions.
Demonstrated knowledge of material, methods, instruments and equipment.
Demonstrated ability to read, write and perform mathematical calculations.
Ability to multi-task, work in a fast-paced environment and manage time accordingly to meet deadlines and requirements of the organization.
Advanced knowledge of payer contracting, managed-care principles, reimbursement structures, and healthcare financial analysis.
Strong negotiation skills with the ability to build productive relationships while advocating for organizational priorities.
Ability to evaluate complex data and translate findings into practical business recommendations.
Strong executive presence and the ability to communicate effectively with physicians, senior leaders, payer representatives, and cross-functional teams.
Excellent judgment, analytical thinking, and problem-solving skills.
Ability to manage multiple priorities, deadlines, and negotiations in a fast-paced healthcare environment.
Strong written, verbal, and presentation skills.
High level of professionalism, discretion, and integrity when handling confidential financial and contractual information.
Proficiency with Microsoft Office applications and the ability to work with contract-management, reporting, and analytics tools.
Bachelor’s degree in healthcare administration, business administration, finance, economics, or a related field required.
Eight or more years of progressive experience in payer relations, managed-care contracting, reimbursement strategy, healthcare finance, revenue cycle, or a related field.
Demonstrated ability to interpret complex contract language, fee schedules, reimbursement methodologies, and payer policies.

Nice To Haves

Master’s degree in business administration, healthcare administration, or a related field preferred.
Five or more years of leadership experience preferred.
Experience negotiating payer contracts for a multi-location medical practice, specialty physician group, ambulatory surgery center organization, or healthcare system strongly preferred.
Experience with ophthalmology, optometry, surgical services, or specialty healthcare reimbursement is highly desirable.

Responsibilities

Develop and execute a comprehensive payer-relations strategy that aligns with the organization’s clinical, operational, and financial goals.
Advise executive leadership on payer trends, reimbursement risks, contracting opportunities, and market developments.
Establish priorities for payer negotiations based on reimbursement performance, patient access, geographic expansion, service-line growth, and organizational needs.
Evaluate the financial and operational impact of payer policies, contract terms, and reimbursement changes.
Support strategic planning for new practice locations, physician groups, ambulatory surgery centers, and other affiliated services.
Represent the organization in executive-level discussions with health plans and other payer partners.
Lead negotiations for commercial, Medicare Advantage, managed Medicaid, and other applicable payer agreements.
Evaluate contract terms, reimbursement methodologies, fee schedules, payment policies, network requirements, and administrative provisions.
Partner with Finance and Revenue Cycle leadership to model the financial impact of proposed agreements and contract amendments.
Ensure contracts support appropriate reimbursement for ophthalmology services, including office visits, diagnostic testing, procedures, surgical services, and specialty care.
Maintain a centralized process for monitoring contract terms, renewal dates, amendments, notice periods, and key obligations.
Identify opportunities to improve reimbursement, strengthen contract language, and reduce administrative burden.
Coordinate with legal counsel as appropriate when reviewing or negotiating agreements.
Build and maintain productive relationships with payer executives, provider-relations representatives, contracting teams, and medical-management leaders.
Serve as an escalation point for high-impact payer issues affecting reimbursement, patient access, claims processing, prior authorization, or provider participation.
Conduct regular payer meetings and business reviews to address performance, policy changes, operational concerns, and opportunities for collaboration.
Promote timely communication between payers and internal stakeholders.
Develop strategies to strengthen payer partnerships while protecting the organization’s financial and operational interests.
Partner with Finance and Revenue Cycle teams to monitor reimbursement trends, payer performance, denials, payment accuracy, and contract compliance.
Analyze reimbursement by payer, service line, provider, location, and procedure category to identify opportunities and risks.
Support the development of reporting tools and dashboards that provide visibility into payer performance.
Identify underpayments, payment variances, and systemic reimbursement issues requiring payer escalation or corrective action.
Develop strategies to improve net revenue, reduce payment delays, and address unfavorable reimbursement trends.
Assess the potential impact of proposed payer policy changes and recommend appropriate organizational responses.
Evaluate payer network-participation opportunities based on patient access, market presence, reimbursement, administrative requirements, and strategic value.
Support the organization’s participation in payer networks that align with growth plans and patient-care objectives.
Monitor network status and help address issues that may affect patient access or provider directory accuracy.
Partner with Credentialing and Provider Enrollment teams to promote timely payer enrollment and accurate participation records.
Coordinate payer-relations activities related to physician onboarding, practice acquisitions, new locations, and service expansions.
Collaborate with Revenue Cycle, Finance, Operations, Credentialing, Compliance, Legal, Clinical Leadership, and Information Technology teams.
Translate contract requirements and payer policies into clear guidance for operational teams.
Partner with practice leaders to identify payer-related barriers affecting scheduling, patient access, authorizations, claims, or collections.
Provide education and updates to leadership regarding material payer changes and emerging issues.
Support due diligence and integration planning for organizational growth initiatives, including acquisitions and new market entry.
Maintain knowledge of healthcare reimbursement trends, payer policies, managed-care practices, and applicable regulatory developments.
Monitor changes that may affect ophthalmology reimbursement, ambulatory surgery center payments, prior authorization requirements, and patient access.
Partner with Compliance and legal counsel to support adherence to applicable laws, regulations, contractual obligations, and organizational policies.
Maintain appropriate confidentiality and professional discretion when handling sensitive business information.
Lead, develop, and support payer-relations team members and other assigned staff.
Establish goals, performance measures, workflows, and accountability standards.
Foster a collaborative culture focused on data-informed decision-making, timely follow-up, and continuous improvement.
Promote effective communication across departments and ensure payer-related initiatives remain aligned with organizational priorities.