VP, Operations

Reliant Health Partners seeks a seasoned Vice President of Operations to lead and transform a multifunction healthcare cost-containment organization. This executive will oversee approximately 25 employees across complex, time-sensitive claims and provider-facing operations, establish rigorous management controls, and build scalable, technology-enabled workflows. The role requires deep knowledge of the federal No Surprises Act (NSA), open negotiation, and Independent Dispute Resolution (IDR), as well as a proven ability to lead managers, manage operational risk, and deliver measurable outcomes. The VP role will help shape the organization’s future structure, leadership model, and reporting relationships.

Job Responsibilities

• Manage the team negotiating NSA disputes before IDR, ensuring deadlines, documentation, outcomes, and handoffs are controlled.
• Own end-to-end IDR operational performance, including correspondence intake, case identification and matching, filing and final-offer milestones, decisions, repricing, adjusted explanations of reimbursement (EORs), client notifications, exceptions, and audit trails.
• Lead negotiation and resolution of appeals related to the company’s out-of-network repricing products.
• Oversee Provider Data Management (PDM), including data-entry and related data-management activities, quality, throughput, capacity, and automation opportunities.
• Lead Client Services, the internal support operation serving other company functions, with clear service levels, issue ownership, and escalation.
• Oversee the dedicated Medicaid claims repricing operation supporting the Kaiser account.
• Own operating results across all assigned units, including quality, timeliness, productivity, service, compliance, capacity, and cost.
• Implement a consistent operating-management system with dashboards covering intake, backlog and aging, throughput, turnaround, staffing productivity, exceptions, deadlines, and trends.
• Design and document end-to-end process maps, clear handoffs, accountable owners, escalation pathways, reconciliations, and evidence of completion.
• Build robust NSA/IDR controls for receipt and classification of communications, critical dates, claim-to-dispute matching, client communication, financial exposure, and auditability.
• Lead cross-functional redesign with IT, product, finance, legal/compliance, and account management, translating business requirements into prioritized technology roadmaps.
• Identify and responsibly deploy AI, document intelligence, and workflow automation to reduce manual work, improve classification and routing, surface exceptions, and enhance accuracy, with appropriate human review, privacy, and control safeguards.
• Develop demand-based staffing and capacity models, resource plans, budgets, succession coverage, and organizational structure, recommending additional management layers when warranted.
• Coach and hold managers accountable, delegate effectively, and establish a cadence of weekly performance reviews, risk escalation, and continuous improvement.
• Communicate emerging risks promptly and bring decision-ready recommendations, tradeoffs, and resource requirements to executive leadership.
• Support enterprise integration, standardization, growth, and acquisition readiness without compromising client commitments or controls.
• Within the first 90–180 days, establish a reliable baseline of volume, backlog, aging, throughput, turnaround, productivity, quality, critical deadlines, and client-facing exceptions for every assigned function.
• Validate immediate IDR risk controls, outstanding-decision reconciliation, case ownership, timely client communication, and escalation mechanisms.
• Produce documented current-state workflows and a prioritized, funded, owner-assigned improvement roadmap with IT.
• Implement recurring operating reviews, accountable managers, coverage plans, and clear decision rights.
• Present a sustainable staffing and leadership structure, including any justified additional layer of management.

Qualifications

• 15+ years of progressive healthcare operations experience, including substantial senior leadership responsibility for complex, multi-team operations.
• Demonstrated hands-on expertise in the federal No Surprises Act, open negotiation, federal IDR processes, out-of-network claims and repricing, and associated operational deadlines and communications.
• Proven record of building KPI-driven management systems, redesigning workflows, improving service and quality, and scaling operations.
• Experience leading managers and cross-functional teams through operational change, technology implementation, and high-stakes issue resolution.
• Strong quantitative and financial acumen, including workload forecasting, staffing models, productivity, and cost management.
• Excellent executive communication, judgment, prioritization, decision-making, and risk-management skills.
• Experience with health plans, third-party administrators, cost-containment vendors, claims administrators, or related payer services (preferred).
• Demonstrated implementation of AI-assisted document processing, intelligent intake, workflow orchestration, and automated operational reporting (preferred).
• Experience with Medicaid repricing, provider data operations, appeals negotiations, or post-acquisition integration (preferred).
• Bachelor’s degree or equivalent experience; advanced degree desirable.

Originally posted on Himalayas