Remote Office Austin, TX 78701 Summary: Presbyterian Healthcare Services (PHS) seeks a strategic ... This leader will define and execute a system-wide payor contracting and revenue optimization ...
Remote Office Austin, TX 78701 Summary: Presbyterian Healthcare Services (PHS) seeks a strategic ... This leader will define and execute a system-wide payor contracting and revenue optimization ...
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Supervisor Practice I | Medicine Centralized Financial Screening | Gainesville
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Quick apply
Accounts Receivable Specialist
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Remote Payor Relations information
What are the most common challenges faced by professionals in remote payor relations roles, and how can they be effectively managed?
What is the difference between Remote Payor Relations vs Remote Claims Specialist?
| Aspect | Remote Payor Relations | Remote Claims Specialist |
|---|---|---|
| Credentials | Healthcare experience, insurance knowledge, communication skills | Medical coding, billing certifications, attention to detail |
| Work Environment | Office or remote, interacting with payers and providers | Remote, processing and reviewing claims |
| Employer & Industry | Healthcare insurers, providers, third-party administrators | Hospitals, clinics, insurance companies |
| Search & Comparison Intent | Understanding payer relations, insurance negotiations | Claims processing, billing, reimbursement issues |
Remote Payor Relations roles focus on managing relationships with insurance payers, negotiating coverage, and ensuring smooth communication. Remote Claims Specialists handle claims processing, billing, and reimbursement tasks. While both roles operate within the healthcare insurance industry and may require similar healthcare knowledge, their core responsibilities differ—one emphasizes payer relations, the other claims management.
What is a remote payor relations specialist?
What are the key skills and qualifications needed to thrive as a remote payor relations specialist?
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Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Re-posted 16 days ago
Job description
Location Address:
Remote Office Austin, TX 78701Summary:
Presbyterian Healthcare Services (PHS) seeks a strategic, influential executive to serve as Vice President of Payer Strategy for the Presbyterian Delivery System (PDS). This is a high-impact role at the intersection of finance, strategy, and payer relations-responsible for shaping how the organization delivers sustainable growth in an increasingly complex reimbursement landscape.This leader will define and execute a system-wide payor contracting and revenue optimization strategy across a diverse and integrated delivery network.
The Vice President will lead negotiations, advance value-based care models, and drive net revenue performance across hospitals, medical group, ambulatory services, and specialty service lines.
This is an ideal role for a seasoned healthcare executive who combines deep reimbursement expertise, strong financial acumen, and executive presence-with the ability to influence both internal stakeholders and external payer partners in a rapidly evolving healthcare environment.
Work Arrangement
Remote: Open to applicants in the United States, excluding CA, IL, ND, NY, OH, WA, and WY.
Hybrid: For individuals within 60 miles of Albuquerque, in-office presence is required Tuesday through Thursday.
Job Description:
Strategic Payor Leadership
Define and execute a system-wide payer contracting strategy aligned with growth, market positioning, and financial performance goals
Develop and implement a comprehensive managed care strategic and tactical plan with clear performance targets
Identify and advance innovative reimbursement models, including value-based and risk-based arrangements
Contracting & Negotiation Excellence
Lead and oversee negotiations of commercial and governmental managed care agreements to secure optimal reimbursement
Serve as authorized signatory for managed care contracts
Continuously evaluate contract performance and lead renegotiation or restructuring efforts as needed
Revenue Optimization & Financial Performance
Drive initiatives to enhance net revenue yield through contract optimization, recovery efforts, and performance monitoring
Analyze reimbursement trends and implement targeted interventions to address risk areas and improve outcomes
Contribute to financial forecasting, budgeting, and capital planning processes
Operational Oversight & Governance
Establish and oversee performance monitoring frameworks and reporting to track managed care outcomes
Ensure robust internal controls, compliance with regulatory requirements, and alignment with enterprise financial systems
Lead system configuration and optimization of contract management tools and reporting capabilities
Organizational Leadership & Collaboration
Lead, mentor, and develop a high-performing managed care and contracting team
Foster cross-functional collaboration across Finance, Revenue Cycle, Operations, Strategy, and Physician Integration
Serve as a trusted advisor to executive leadership, providing insights and recommendations on payor strategy and risk
Relationship Management & Market Influence
Build and sustain strong relationships with managed care organizations and key external stakeholders
Represent PHS in payer negotiations, regulatory discussions, and industry forums
Collaborate across the enterprise to strengthen market position and grow accretive service lines
Success Measures
Within the first 12-24 months, the Vice President will:
Strengthen Contract Performance: Improve reimbursement yield and contract effectiveness across the system
Advance Value-Based Strategy: Expand and optimize value-based agreements with measurable financial and quality outcomes
Enhance Revenue Integrity: Identify and execute net revenue improvement and recovery initiatives
Elevate Payer Relationships: Build strategic, durable relationships with key payor partners
Drive Organizational Alignment: Establish clear accountability, metrics, and governance for managed care performance
Additional Job Description:
Education
Required: Master's degree in Business, Healthcare Administration, Finance, or related field
Knowledge & Work Experience
Experience: Minimum of 15 years of progressive experience in payer strategy, managed care contracting, or healthcare finance
Leadership: Demonstrated success in senior leadership roles within integrated health systems or complex healthcare organizations
Reimbursement Expertise: Deep knowledge of reimbursement methodologies, including fee-for-service, value-based care, risk-sharing, and capitation models
Industry Acumen: Strong understanding of healthcare policy, regulatory environments, and evolving payment models
Core Competencies
Strategic Negotiator: Proven ability to lead high-stakes payer negotiations and secure favorable outcomes
Financial Acumen: Advanced analytical and financial modeling capabilities with strong business judgment
Enterprise Leader: Experience operating within complex, matrixed healthcare systems
Influential Communicator: Ability to translate complex financial concepts into actionable insights for executive and clinical leaders
Relationship Builder: Skilled at developing trust-based relationships with internal stakeholders and external partners
Change Agent: Demonstrated success leading transformation and driving results in dynamic, evolving environments
High Emotional Intelligence: Navigates conflict, complexity, and ambiguity with diplomacy and professionalism
Benefits
Benefits are effective day-one (for .45 FTE and above) and include:
- Competitive salaries
- Full medical, dental and vision insurance
- Flexible spending accounts (FSAs)
- Free wellness programs
- Paid time off (PTO)
- Retirement plans, including matching employer contributions
- Continuing education and career development opportunities
- Life insurance and short/long term disability programs
About Us
Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system ofnine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.
Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.
We are part of New Mexico's history-and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.
About New Mexico
New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great.
Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC.
New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.