Vice President - Payer and Reimbursement Strategy

Beyond Blue

Job Posting Title:

Vice President, Payer and Reimbursement Strategy

Requisition Number:

R-000005173

Department Name:

Blue Shared Services Admin

Work Location:

UK Chandler Hospital, Pavilion H

Grade Level:

27

Type of Position:

Regular

Position Time Status:

Full time

Equivalency Link

https://hr.uky.edu/employment/working-uk/equivalencies

Shift:

Day (United States of America)

Job Description:

How to Apply:

The executive search firm, InTrust Partners, has been retained to recruit for this role. To be considered, applicants must complete the Beyond Blue application for the specific requisition AND contact Amanda Hargrove of InTrust Partners at [email protected].

Job Summary

Responsible for providing executive leadership, strategic direction, and operational oversight for payer strategy, managed care contracting, governmental reimbursement, value-based payment initiatives, and payer operations across the Beyond Blue enterprise. As a member of the Beyond Blue shared services leadership team, the Vice President partners with executive leadership across UK HealthCare, Royal Blue Health, Claire Blue Health, and the Kentucky Medical Services Foundation (KMSF) to align payer strategy with organizational priorities, growth objectives, and sustainable financial performance.

Leads enterprise payer contracting strategies, value-based reimbursement initiatives, governmental reimbursement planning, and reimbursement optimization efforts. Oversees commercial and governmental payer relationships, reimbursement modeling, cost reporting, contract administration, and policy evaluation activities. Serves as the primary executive responsible for identifying, evaluating, and advancing reimbursement opportunities while ensuring compliance with federal, state, payer, and regulatory requirements.

Essential Functions

• Develops and executes enterprise payer strategy aligned with organizational goals, financial objectives, and long-term growth initiatives.

• Provides executive oversight of commercial and governmental reimbursement strategies across the Beyond Blue enterprise.

• Leads development and implementation of payer contracting standards, negotiation strategies, reimbursement methodologies, and value-based payment initiatives.

• Oversees net revenue calculations associated with commercial and governmental payers for monthly financial statements, forecasting, financial planning, and annual budget development.

• Evaluates payer performance, reimbursement trends, healthcare economics, and contracting activities to identify opportunities for revenue enhancement and operational improvement.

• Develops action plans to address reimbursement changes and emerging payment models that impact organizational performance.

• Provides strategic direction regarding reimbursement implications associated with mergers, acquisitions, affiliations, partnerships, and external growth opportunities.

• Serves as executive lead for contract negotiations, contract administration, reimbursement optimization, and payer relationship management.

• Oversees payer contracting activities to maximize reimbursement, strengthen payer relationships, and support organizational priorities.

• Develops and evaluates reimbursement models, contract structures, and financial arrangements supporting enterprise objectives.

• Maintains expertise regarding industry trends, insurer practices, healthcare economics, competitive market conditions, and reimbursement innovations.

• Reviews and evaluates the impact of proposed payment models, reimbursement structures, and healthcare financing initiatives.

• Oversees Medicare, Medicaid, Tricare, and other governmental reimbursement strategies and related financial activities.

• Provides leadership for governmental cost reporting processes, audits, appeals, reimbursement reviews, and regulatory submissions.

• Monitors state and federal reimbursement policy developments and analyzes financial, operational, and strategic impacts.

• Evaluates Commonwealth of Kentucky directed payments and Medicaid Managed Care Organization reimbursement activities to ensure accuracy and consistency.

• Develops organizational recommendations regarding legislative, regulatory, and reimbursement matters affecting healthcare operations.

• Represents the organization in discussions with governmental agencies, policymakers, industry associations, and external stakeholders.

• Serves as the enterprise subject matter expert for payer strategy, reimbursement methodologies, and regulatory reimbursement issues.

• Communicates reimbursement strategies, payer initiatives, and financial impacts to executive leadership and organizational stakeholders.

• Develops business cases, strategic analyses, presentations, and recommendations to support organizational initiatives and investment decisions.

• Collaborates with Revenue Cycle, Finance, Legal, Compliance, Enterprise Quality, External Affairs, and operational leadership to maximize organizational performance.

• Establishes and maintains productive relationships with commercial payers, governmental agencies, healthcare associations, and industry partners.

• Represents the organization through participation in professional organizations, industry groups, and healthcare advocacy efforts.

• Provides executive leadership for payer strategy, reimbursement, managed care contracting, governmental reimbursement, and related operational areas.

• Establishes departmental goals, priorities, performance metrics, and accountability standards.

• Provides leadership, coaching, mentoring, performance management, and professional development for payer strategy, reimbursement, and contracting personnel while supporting recruitment and retention initiatives.

• Develops and mentors payer strategy and reimbursement leadership personnel.

• Creates a culture of accountability, collaboration, innovation, and continuous improvement.

• Ensures resources are appropriately aligned to support organizational objectives and maximize operational performance.

• Ensures compliance with all applicable federal, state, payer, and regulatory requirements affecting reimbursement activities.

• Oversees development and implementation of policies, procedures, and operational controls related to payer administration and reimbursement functions.

• Identifies organizational reimbursement risks and develops mitigation strategies.

• Maintains expertise regarding healthcare reimbursement regulations, managed care requirements, and payment reform initiatives.

• Supports enterprise governance, compliance, and audit activities associated with reimbursement programs.

• Performs other duties as assigned.

Education Requirement

Master’s degree in Business Administration, Accounting, Finance, Public Health, Healthcare Administration, Economics, or a related field.

Experience Requirement

10 years of progressively responsible experience in healthcare finance, managed care contracting, payer administration, reimbursement strategy, revenue cycle operations, governmental reimbursement, healthcare economics, or related field.

Demonstrated experience leading payer strategy, reimbursement operations, contract negotiations, and financial planning activities within a complex healthcare organization.

Progressive executive leadership experience managing organizational functions, strategic initiatives, and multidisciplinary teams required.

Experience working with commercial payers, governmental agencies, healthcare systems, academic medical centers, or integrated delivery networks preferred.

An equivalent combination of education and experience may be considered.

All experience must be paid and in the same related field.

Part-time and PRN experience will be prorated based on hours worked per week.

Volunteer work and internships for academic credit are not counted.

Certifications & Licensures

N/A

Working Conditions

A. Lifting, pushing, and/or pulling objects up to 50lbs: 2. Occasional (<10% of the time)

B. Lifting, pushing, and/or pulling objects over 50lbs: 1. Never

C. Standing or walking with objects up to 10lbs: 2. Occasional (<10% of the time)

D. Standing or walking with objects up to 25lbs: 1. Never

E. Sitting at computer workstation for extended periods: 3. Intermittent (10% - 50% of the time)

F. Risk of back injury from moving, lifting, or positioning equipment or materials: 1. Never

G. Repetitive motion: 3. Intermittent (10% - 50% of the time)

H. Working at heights above 4 feet: 1. Never

I. Working in confined spaces: 1. Never

J. Risk of injuries from use of equipment on the job: 1. Never

K. Job-related travel: 2. Occasional (<10% of the time)

L. Loud noises: 1. Never

M. Temperature extremes: 1. Never

N. Hazardous chemicals and fumes including waste: 1. Never

O. Radiation: 1. Never

P. Burns: 1. Never

Q. Cuts/Punctures: 1. Never

R. Bloodborne/airborne pathogens: 1. Never

S. Recombinant DNA or viral vectors: 1. Never

T. Combative/violent people: 1. Never

U. Animal handling (including carcasses): 1. Never

V. Please specify other(s) and amount of exposure (i.e. Occasional, Intermittent or Regular): N/A

Physical Demands

This position requires intermittent sitting at a computer workstation for extended periods of time; performing tasks involving repetitive motions such as typing, report preparation, financial modeling, contract review, and strategic analysis; and occasional standing or walking with objects weighing up to 10 pounds, as well as occasional lifting, pushing, and/or pulling objects weighing up to 50 pounds. Occasional travel may be required to support meetings, payer negotiations, industry events, governmental affairs activities, and organizational initiatives.

Our University Community

We value the well-being of each of our employees and are dedicated to creating a healthy place for everyone to work, learn and live. In the interest of maintaining a safe and healthy environment for our students, employees, patients and visitors, the University of Kentucky is a Tobacco & Drug Free campus.

The University follows both the federal and state Constitutions as well as all applicable federal and state laws on nondiscrimination. The University provides equal opportunities for qualified persons in all aspects of institutional operations and does not discriminate on the basis of race, color, national origin, ethnic origin, religion, creed, age, physical or mental disability, veteran status, uniformed service, political belief, sex, sexual orientation, gender identity, gender expression, pregnancy, marital status, genetic information or social or economic status.

Any candidate offered a position may be required to pass pre-employment screenings as mandated by University of Kentucky Human Resources. These screenings may include a national background check and/or drug screen.