Payer Contracting, Policy and Regulatory Counsel

The Payer Contracting Policy & Regulatory Counsel serves as the lead legal regulatory and strategic advisor for payer contracting activities across the University of Vermont Health Network. As a key member of the integrated Payer Strategy and Contracting team this role bridges traditional managed care contracting value-based care contracting payer policy analysis regulatory interpretation dispute resolution and contract performance management.

Unlike a traditional healthcare attorney focused solely on legal review this position functions as a strategic business partner supporting payer negotiations reimbursement strategy payment innovation and enterprise-wide value-based transformation. The role works closely with contracting finance population health operations revenue cycle and executive leadership to ensure payer agreements advance organizational objectives related to financial performance care transformation quality outcomes and population health management.
The position provides legal and strategic counsel regarding commercial payer agreements Medicare Advantage contracts Medicaid managed care arrangements accountable care organization agreements alternative payment models value-based reimbursement programs payer policies regulatory compliance contract disputes and payment integrity matters. The role serves as the organizations subject matter expert on payer contract interpretation reimbursement policy and regulatory developments impacting payer-provider relationships.

Reports to: Vice President Payer Strategy Contracting

Key relationships: High Value Care leadership / CFOs / Population Health / Revenue Cycle /Legal Compliance /Finance / Clinical Leaders / payer representatives / outside counsel

EDUCATION
Required
Juris Doctor (JD) from an accredited law school.
Licensed and in good standing with the Vermont Bar or eligible for admission.
Preferred

Additional education or certification in:Healthcare Administration / Healthcare Finance / Compliance / Population Health / Value-Based Care

EXPERIENCE
Required
Minimum of 7 years of progressively responsible experience in healthcare law managed care contracting or payer strategy.
Significant experience negotiating and reviewing complex healthcare contracts.
Demonstrated experience resolving payer disputes and reimbursement issues.
Experience interpreting healthcare regulations and payer policy requirements.
Preferred

Experience within an integrated delivery network academic medical center health system or payer organization

Experience with:

• Commercial payer negotiations

• Medicare Advantage contracting

• Medicaid managed care programs

• Value-based care arrangements

• Accountable Care Organizations

• Population health initiatives

• Specialty pharmacy reimbursement