Position SummaryThe Vice President of Payor Relations leads Centria's enterprise payor strategy and relationships across commercial and Medicaid payors. This role personally manages the commercial payor portfolio, including executive relationships, contracting, rate strategy, network positioning, issue escalation, and growth opportunities. The Vice President directly oversees the Area Vice President of Payor Relations for Medicaid, who manages the day-to-day Medicaid payor portfolio. This role partners across Growth, Clinical, Operations, Finance, Revenue Cycle, Legal, and Compliance to improve payor access, reimbursement, administrative performance, and long-term partnerships. The role does not oversee Centria's sales team or provider-referral sales activities.
Duties and ResponsibilitiesThe below reflects the essential functions considered necessary for this role and shall not be construed as a detailed description of all work requirements inherent in the job or assigned by supervisory personnel. This job description is used as a guide only and not inclusive of all responsibilities and job duties.
- Develop and execute Centria's enterprise payor strategy across commercial and Medicaid lines of business, aligned with growth, access, quality, and financial objectives.
- Personally manage the commercial payor portfolio, including executive relationships, contract negotiations, reimbursement strategy, network participation, escalations, and partnership opportunities.
- Keep current on all regulatory changes in our markets as well as across the country.
- Lead and oversee the Area Vice President of Payor Relations for Medicaid; set priorities, review payor-specific action plans, coach performance, and ensure effective management of state Medicaid agencies and managed care organizations.
- Build senior relationships with national, regional, and local payors and position Centria as a reliable, high-quality, outcomes-driven, and cost-effective autism services provider.
- Lead contract strategy and reform, including reimbursement, rate-escalation mechanisms, notice provisions, authorization requirements, payment terms, network access, and other protections.
- Maintain payor-specific strategies for priority accounts, including objectives, relationship maps, opportunities, risks, commitments, owners, timelines, and measurable outcomes. In addition, oversee our Payor Relations Specialist (PRS) team, who is responsible for building relationships at the local level with payors and their case managers to create access and speed to care for their members.
- Partner with Finance and Revenue Cycle to monitor payor economics and performance, including reimbursement, denials, underpayments, accounts receivable, payment trends, and root-cause resolution.
- Partner with Clinical, Operations, Credentialing, Authorizations, Compliance, Legal, and Growth to remove payor barriers and improve access, credentialing, authorization, billing, quality reporting, and client experience.
- Identify value-based arrangements, case rates, alternative payment models, outcomes partnerships, and other innovations that improve quality, access, affordability, and administrative efficiency.
- Monitor payor policy, regulation, market, and competitive developments; assess business impact and coordinate Centria's response with Legal, Compliance, and operational leaders.
- Represent Centria in payor meetings, regulatory discussions, and industry forums; ensure external commitments are documented and fulfilled.
- Establish payor-relations KPIs and governance; report to executive leadership on payor mix, rates, contract status, access, cycle times, denials, risks, and key initiatives.
- Maintain appropriate documentation of payor communications, decisions, approvals, contract changes, and follow-up actions.
- Coordinate effectively with Sales when payor access affects growth, while maintaining no ownership of the sales function.
- Perform other duties as assigned.
- Comply with Centria's Code of Conduct, policies and procedures, and applicable federal and state laws.
- Responsibility to report violations of Company policies or the Code of Conduct.
RateQualificationsEducation- Bachelor's degree in business, healthcare administration, finance, public policy, or a related field
- Master's degree preferred
Work Experience- 10+ years of progressive experience in payor relations, managed care, healthcare contracting, network management, or a related field
- 5+ years of leadership experience, including responsibility for developing and managing senior team members
- Demonstrated experience managing commercial and/or Medicaid payor relationships; behavioral health, autism services, or multi-state healthcare experience strongly preferred
Equipment and Technology Requirements- Working knowledge of laptop/desktop PC
- Proficiency in Microsoft Suite (Word, Excel)
- Proficiency in G Suite (Gmail, Drive, Docs, Sheets, Google Meet)
Other Competency Requirements- Ability to follow written instructions
- Ability to use computers and computer/software programs
- Ability to communicate expressively and receptively
Knowledge and Skills- Proven executive leadership and people-management skills, with the ability to set direction, create accountability, and develop high-performing leaders.
- Deep knowledge of commercial and Medicaid payor contracting, reimbursement, network strategy, authorization, credentialing, claims, and regulatory environments.
- Ability to negotiate complex agreements and translate contract terms into operational and financial impact.
- Strong executive presence and relationship-management skills with payor, regulatory, and internal senior leaders.
- Strong analytical and financial acumen, including interpretation of reimbursement, utilization, denial, accounts-receivable, and payor-mix data.
- Ability to develop payor-specific strategies, prioritize opportunities and risks, and drive cross-functional execution.
- Excellent written and verbal communication skills, including executive reporting and persuasive external presentations.
- Sound judgment and problem-solving skills in complex, high-stakes, and rapidly changing situations.
- Ability to manage multiple initiatives, meet deadlines, and consistently produce high-quality work.
- Ability to collaborate across Clinical, Operations, Finance, Revenue Cycle, Legal, Compliance, Credentialing, Authorization, and Growth.
- High integrity, attention to detail, and commitment to compliant and accurate documentation.
Working Conditions- Centria's office hours are Monday through Friday from 8:30 AM - 6:00 PM.
- This is a remote position requiring approximately 25% or more travel for payor meetings, team leadership, regulatory or industry events, and business needs.
- Additional time, schedule flexibility, or extended travel may be required to meet company objectives.
Physical DemandsWhile performing this job, the team member regularly uses a computer and telephone and may sit, stand, walk, bend, reach, lift, push, or pull up to 30 pounds. The role requires close visual acuity for computer work and the ability to travel by air or automobile.
