Vice President, Payer Relations

Responsibilities

• Serve as Hopebridge’s senior executive interface with Medicaid and commercial payers across all service lines and states.
• Own payer contracting strategy, reimbursement sustainability, and network positioning for ABA, Speech, OT, and behavioral health services.
• Lead payer strategy related to organizational and provider‑structure complexity, including:
• Planned reduction of individual NPIs
• Establishment and management of additional TINs
• Alignment of payer contracts, network participation, and reimbursement to evolving entity and identifier structures
• Lead payer discussions, contract amendments, and risk mitigation associated with NPI/TIN transitions to ensure continuity of care and revenue integrity.
• Operate within the Revenue Cycle, owning payer strategy, sequencing, and payer‑facing risk management, working in close partnership with Revenue Cycle leadership (including Credentialing) to align:
• Payer requirements and expectations
• Credentialing timelines and enrollment readiness
• Go‑live sequencing and transition planning
• Anticipate and mitigate payer risks associated with structural changes—including credentialing delays, authorization mismatches, network gaps, or reimbursement disruption—through proactive planning and coordination.
• Act as the executive owner of payer readiness during structural or market transitions, ensuring payer systems, internal platforms, and center‑level operations are aligned before changes are implemented.
• Serve as a strategic advisor to the executive team on payer risk, market and state‑level viability, and decisions affecting center footprint and staffing.
• Ensure payer strategy supports stable operations, regulatory compliance, and sustainable growth—not growth at all costs.
• Drive disciplined payer governance through scorecards, payer business reviews, and escalation of systemic payer risks.

Qualifications

Required:

• Bachelor’s degree in Business Administration, Healthcare Management, or a related field
• Minimum 10 years of progressive healthcare payer relations experience, including experience in Medicaid and commercial payers
• Experience leading payer strategy and negotiations, including experience with NPI/TIN transitions
• Strong understanding of healthcare reimbursement models, including Medicaid and commercial insurance
• Proven ability to build and maintain strong relationships with key stakeholders, including payers, providers, and regulators
• Excellent communication and negotiation skills
• Ability to manage multiple priorities and deadlines effectively

Preferred:

• MBA or Master’s degree in Healthcare Administration or related field
• Experience in pediatric behavioral health or related fields
• Experience in managing large-scale payer networks