VP of Payer Relations

Job description

Our vision is a world of peaceful relationships with food, weight, and body image, where everyone with an eating disorder can experience recovery. We believe that exceptional, individualized care leads to lasting recovery from eating disorders. That’s why our teams are comprised of compassionate, dedicated professionals from a variety of backgrounds who collaborate to provide the very best evidence-based care for our clients at all levels of care. **Position Overview** The Vice President of Payer Relations is a senior executive responsible for defining and leading The Emily Program’s payer strategy across commercial, Medicaid/ Medicare, and other managed care partners. This leader ensures sustainable reimbursement, expanded access to care, and alignment between payer contracts and The Emily Program’s specialized eating disorder care delivery model across all levels of care (inpatient, residential, PHP, IOP, outpatient, virtual services). The VP serves as the organization’s primary executive liaison with payers and leads all payer-facing strategy, including contract negotiations, reimbursement innovation, and payer performance governance. This is a transformational leadership role responsible for advancing The Emily Program’s payer strategy from a transactional contracting model to an enterprise, strategic, and value-driven partnership model. **Salary Range: $180,000 - $210,000 Base Salary** Commensurate with experience and competencies of the role. **Location:** Remote - Must be located in the United States. **How VP of Payer Relations Empower Recovery:** **Enterprise Payer Strategy** - Develop and execute a unified payer strategy across The Emily Program. - Advise executive leadership on payer risks, reimbursement trends, and strategic opportunities. - Aligning payer strategy with organizational growth priorities, including new markets, services, and partnerships **Contracting & Negotiation Leadership** - Lead all aspects of payer contracting, including: - In-network agreements - Out-of-network strategies and single case agreements - Contract renewals, amendments, and dispute resolution. - Structure contracts that appropriately reflect: - Acuity and complexity of eating disorder and behavioral health care - Length of stay considerations. - Level-of-care differentiation (RTC, PHP, IOP, outpatient, virtual services) - Partner closely with Legal and Compliance to mitigate regulatory and contractual risk. **Payer Relationship Management** - Serve as the executive point of contact for national, regional, and local payer relationships. - Build long-term strategic partnerships with key payer stakeholders. - Lead executive-level discussions around: - Access to care - Medical necessity criteria - Authorization requirements - Network participation strategy - Act as escalation point for complex payer disputes or systemic issues. **Revenue & Performance Oversight** - Partner with Revenue Cycle Management and Finance to: - Monitor reimbursement rates and revenue yield. - Assess denial trends and authorization challenges. - Ensure contract terms are operationalized effectively. - Improve net revenue realization. - Reduce denials and underpayments. - Develop payer scorecards and report for executive leadership. **Clinical & Operational Alignment** - Partner with Clinical Leadership to ensure payer policies align with evidence-based care models. - Support advocacy around: - Medical necessity for eating disorder treatment. - Appropriate level-of-care placement - Continuity of care - Collaborate with Operations to ensure payer requirements are executable across all sites. **arket Intelligence & Innovation** - Monitor payer policy, mental health parity enforcement, and behavioral health regulatory developments. - Lead strategy for: - Value-based care initiatives - Alternative payment models - Risk-based arrangements. - Identify opportunities to improve payer mix and expand access to covered services. **Education Qualifications:** - Bachelor’s degree in business, Healthcare Administration or related field, required. Advanced degrees (MBA, MHA, MPH, or JD), preferred. **Professional Qualifications: (Preferred)** - 10+ years of experience in payer relations, managed care, or healthcare contracting. - Minimum 7 years in senior leadership roles with a track record of managing and developing successful teams. - Deep expertise in behavioral health reimbursement (strongly preferred: eating disorder treatment) - Demonstrated success negotiating complex payer agreements in multi-state environments. - Excellent analytical and problem-solving skills, with a data-driven approach to decision-making. - Effective communication and interpersonal skills, with the ability to collaborate effectively across departments. - Demonstrated success in creating revenue upside through payer strategy. - Strong command of challenges and risks in Health Plans, Hospital, and Provider Group markets. - Experience with: - Residential and sub-acute behavioral health reimbursement - Medicaid managed care across multiple states - Out-of-network and SCA negotiations - Prior relationships/experience with payers in one or more of the following footprint states (MN, OH, WA, PA, NC, GA). **What we offer:** **Employee Benefits:** We understand the importance of a well-rounded benefits package. That’s why we’re dedicated to providing a range of plans to meet your needs. For full-time employees, we offer: - HSA and PPO insurance with HSA or FSA options (Blue Cross Blue Shield) - Dental insurance (Delta Dental) - Vision insurance (EyeMed) - Short-term and long-term disability insurance - Company-paid life insurance - 401(k) plan available two months after start date - Company 401(k) matching for up to 50% of your contribution, up to 6% of your compensation Paid time off is a crucial part of maintaining work and life balance. Our generous PTO plan accrues annually and begins with your first whole pay period. Eligible employees enjoy seven paid holidays and one floating holiday in addition to their regular PTO.