Vice President, Payer Relations

Job Description

Job Description

The Vice President of Payer Relations is the senior executive accountable for payer strategy, contracting, and payer‑driven risk across Hopebridge’s Applied Behavior Analysis (ABA), Speech Therapy, Occupational Therapy (OT), and related pediatric behavioral health services. This role operates across complex Medicaid and commercial payer environments where reimbursement, utilization management, network decisions, and provider‑structure changes directly impact access to care, staffing models, and financial sustainability.

The role owns payer‑facing strategy and external leadership—not transactional execution—and works through disciplined partnership with Revenue Cycle, Clinical Operations, Intake/Access, Compliance, and Finance to ensure payer decisions are operationally executable. Responsibilities Scope of Accountability

• 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.

Operating Model & Cross‑Functional Partnership

• Credentialing, enrollment, and claims execution sit within Revenue Cycle.
• This role owns 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.

Executive Leadership Role

• 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.