Vice President of Payor Relations

Location: Franklin, TN, 37064 | Full-Time | Hybrid/Remote Options Available

About Us:

Reliable Medical is a leading provider of Complex Mobility Solutions and other critical services for customers seeking compassionate care and optimal outcomes. We specialize in providing high-quality medical equipment and customized solutions while fostering strong relationships with healthcare providers, payors, and patients. Our mission is to improve the lives of those we serve by providing best-in-class service to customers, education, product expertise, and dedicated partnership to clinicians, as well as development, career satisfaction, and work-life balance to our team members. We aspire to bring our mission to new communities and to reinvest our growth into improving lives, treating one another and our customers like family.

Position Summary:

The Vice President of Payor Relations will be responsible for leading and executing our payor strategy, securing favorable contracts, and ensuring compliance with reimbursement policies. This role will develop and strengthen relationships with private insurers, Medicare, Medicaid, and managed care organizations to enhance reimbursement structures, optimize revenue, and expand patient access to essential DME and CRT services.

Key Responsibilities:

• Strategic Payor Contracting & Negotiation:
  • Lead negotiations with commercial insurers, Medicare Advantage plans, Medicaid Programs, and other third-party payors to secure competitive reimbursement rates and contract terms.
  • Analyze existing contracts and identify opportunities for optimization and expansion.
  • Develop innovative contracting strategies, including value-based reimbursement models.
• Payor Credentialing and Network Participation
  • Oversee the credentialing and recredentialing processes for all providers within the organization.
  • Ensure timely enrollment and participating in Medicare, Medicaid, managed care, and commercial insurance networks.
  • Work closely with the compliance and revenue cycle teams to address credentialing delays and resolve payor enrollment issues.
  • Maintain accurate records of provider credentialing status and ensure adherence to payor specific requirements.
• Relationship Management & Advocacy:
  • Build and maintain strong relationships with payors, government agencies, and industry stakeholders to advocate for reimbursement policies that support DME and CRT providers.
  • Represent the company in industry coalitions, lobbying efforts, and payor policy discussions to influence favorable reimbursement regulations.
• Reimbursement & Compliance Oversight:
  • Ensure compliance with CMS, Medicaid, and private insurance guidelines related to DME and CRT coverage.
  • Monitor industry trends, regulatory changes, and payor policies that impact reimbursement, adapting strategies accordingly.
  • Partner with billing, revenue cycle, and legal teams to mitigate risks and address reimbursement challenges.
• Business Growth & Market Expansion:
  • Identify new contracting opportunities to expand service offerings and improve patient access to DME and CRT products.
  • Lead market research initiatives to assess competitive reimbursement benchmarks and emerging industry trends.
  • Support M&A Activities by evaluating payor contracts and reimbursement structures in potential acquisitions.
• Leadership & Collaboration:
  • Provide strategic direction to internal teams, including revenue cycle, billing, legal, and compliance.
  • Partner with the sales and operations teams to ensure seamless integration of payor strategies into business operations.
  • Mentor and develop a high-performing payor relations team.

Qualifications:

• 10 years of experience in payor contracting, provider relations, or reimbursement strategy within the DME, CRT, or healthcare industry.
• Proven track record of negotiating complex payor contracts and securing favorable reimbursement rates.
• Experience managing provider and enrollment processes.
• Strong knowledge of Medicare, Medicaid, private insurance, and managed care reimbursement policies related to DME and CRT.
• Experience in value-based care models, alternative payment structures, and provider-payor collaboration.
• Strong understanding of regulatory requirements, compliance risks, and revenue cycle management.
• Excellent negotiation, relationship management, and advocacy skills.
• Bachelor’s degree required; MBA, MHA, or JD preferred.

Why Join Us?

• Be a key leader in a mission-driven company dedicated to improving patient mobility and independence.
• Opportunity to shape the future of DME and CRT payor strategy.
• Work in a collaborative, growth-oriented environment with a passionate team.