Vice President, Payer & Government Relations

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🔥 19 hours ago

🐊 Florida, Kansas, +2 more states – Remote

🐊 Florida – Remote 🌪️ Kansas – Remote ❄️ Minnesota – Remote 🤠 Texas – Remote

⏰ Full Time

🔴 Lead

👔 Vice President

👻 Ghost score 22%

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Pediatric Home Service

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1990

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare • Home Care

Pediatric Home Service is dedicated to providing specialized care for children with medical complexities in the comfort of their homes. Their mission focuses on offering a range of services, including respiratory therapy, clinical nutrition, infusion nursing, and durable medical equipment to support the health and wellbeing of pediatric patients. By ensuring that children can thrive at home, Pediatric Home Service also enables parents and caregivers to focus on family, enriching the lives of children with serious health challenges.

📋 Description

• Build and maintain strategic relationships with health plans and other payer partners • Manage the payer contract lifecycle to support sustainable reimbursement for PHS services • Lead and support payer contract negotiations, renewals, and strategic discussions • Monitor payer performance and identify reimbursement, contractual, and operational issues • Partner with Revenue Cycle and operational teams to resolve escalated payer issues • Analyze payer requirements, reimbursement trends, and contractual changes and assess their impact on PHS • Advocate for reimbursement structures and payer policies supporting access to pediatric home-based care • Monitor legislation, regulations, and public policy developments affecting PHS, employees, and the children and families served • Analyze legislative and regulatory developments and translate them into business and operational impacts • Develop and support advocacy strategies advancing PHS priorities • Build awareness and support for PHS services among policymakers, legislators, government agencies, and other stakeholders • Represent PHS with trade associations, coalitions, state agencies, legislative committees, and external organizations • Develop relationships with individuals, groups, agencies, and officials influencing healthcare policy and reimbursement • Participate in legislative and regulatory discussions and advocate for access to care for medically complex children • Coordinate internal responses and strategies related to emerging legislative and regulatory issues • Serve as a subject-matter resource to executive leadership on payer, reimbursement, legislative, regulatory, and government affairs matters • Prepare reports, recommendations, presentations, and executive communications regarding payer and government-relations initiatives • Educate internal stakeholders on payer, legislative, and regulatory developments • Gather and analyze data supporting payer negotiations, advocacy initiatives, policy positions, and strategic decisions • Translate complex policy, regulatory, reimbursement, and contractual information into clear recommendations • Partner cross-functionally with Legal, Revenue Cycle, Finance, Operations, Clinical Services, and other teams • Identify emerging risks and opportunities and proactively recommend strategies to leadership • Represent PHS professionally with external stakeholders, industry partners, and public officials • Exercise sound judgment and discretion when managing confidential and sensitive matters

🎯 Requirements

• Bachelor’s degree required; Master’s degree in Healthcare Administration, Business Administration, Finance, or related field preferred • 10+ years of progressive leadership experience in payer relations, managed care contracting, or healthcare revenue cycle • Demonstrated success negotiating competitive reimbursement rates ad complex contract structures • Experience developing national payer relationships and executing multi-market contracting strategies • Deep understanding of reimbursement methodologies, regulatory requirements, and healthcare financial operations • Proven ability to structure innovative payment arrangements aligned with clinical outcomes and service complexity • Strong analytical skills, negotiation skills, executive presence, and ability to influence senior payer leadership • Government affairs, legislative advocacy, regulatory affairs, or healthcare public policy experience preferred • Experience monitoring and analyzing proposed legislation, regulatory changes, and healthcare policy and assessing potential organizational impact preferred • Experience building relationships with legislators, government agencies, health plans, trade associations, coalitions, and advocacy organizations preferred • Experience representing an organization before policymakers, government agencies, industry associations, or other external stakeholders preferred • Experience 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 different payer, Medicaid, legislative, and regulatory environments preferred • Experience within 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 support payer negotiations and advocacy initiatives preferred • Experience developing or supporting alternative, value-based, or other innovative payment arrangements preferred • Experience 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 preferred

🏖️ Benefits

• Generous Paid Time Off (PTO) for full time employees to ensure a healthy work-life balance • 401(k) Matching to help secure your future • Tuition Reimbursement to support your educational and professional growth • Professional Development & Learning Opportunities to expand your skills and knowledge in pediatric care • Health and Dental insurance • Short & Long Term Disability and Life Insurance

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