VP, Payer Relations

JOB SUMMARY:

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.

ESSENTIAL JOB FUNCTIONS (other duties as required):

Adherence to applicable laws, regulations, and contractual obligations. Follows the principles of the Compliance Program as well as the US Eye Code of Conduct. 

Payer Strategy and Executive Leadership

• 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.

Contract Negotiation and Management

• 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.

Payer Relationship Management

• 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.

Reimbursement and Financial Performance

• 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.

Network Participation and Patient Access

• 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.

Cross-Functional Collaboration

• 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.

Regulatory and Industry Awareness

• 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.

Team Leadership

• 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.

Reasonable accommodation may be given to individuals with disabilities to perform the essential functions. 

COMPETENCIES:

• 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.

SUPERVISORY RESPONSIBILITIES:

The VP of Payer Relations carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws.  Responsibilities include interviewing, hiring and training employees, planning, assigning and directing work, appraising performance, rewarding and disciplining employees and addressing staff complaints and resolving problems.

WORK ENVIRONMENT:

This position operates primarily in a professional office environment with regular interaction with executive leaders, physicians, operational teams, and external payer representatives. The role may require travel to practice locations, ambulatory surgery centers, payer meetings, and industry events

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. 

Demonstrated ability to do excessive walking, standing, bending and stooping.  While performing the duties of this job, the employee is frequently required to stand, sit, use hands to handle or feel objects, tools or control, reach with hands and arms and talk or hear.  The employee is occasionally required to climb or balance, kneel and crouch.

The employee may be required to lift and/or move up to 10 pounds.   Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

POSITION TYPE AND EXPECTED HOURS OF WORK:

This is a full-time salaried position.  Days and hours are Monday through Friday 8:00 A.M. – 5:00 P.M.  Salaried staff may be required to work beyond their set schedule due to business needs and expectations.

TRAVEL:

Travel is required.

REQUIRED EDUCATION AND EXPERIENCE:

• 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.

PREFERRED EDUCATION AND EXPERIENCE:

• 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.

OTHER DUTIES:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job.  Duties, responsibilities and activities may change at any time with or without notice.