VP, Operations

Reliant; Oregon; Hybrid; USD 170,000 - 190,000; Full time

Benefits offered by this job

Comprehensive medical, dental, vision,

401(k) with employer match

HSA & FSAs

PTO and disability leave

Employee Assistance Program (EAP)

Job summary

Reliant Health Partners is seeking a seasoned Vice President of Operations to lead a multi-team healthcare cost-containment organization. You will oversee about 25 employees, implement a robust operating system, and drive AI-enabled workflow improvements while maintaining strict NSA/IDR controls.

The role focuses on cross-functional design, risk management, and scalable processes, with strong executive communication and proven leadership in complex negotiations.

Qualifications

• 15+ years leading complex healthcare operations with multi-team oversight.
• Deep knowledge of the NSA, IDR, out-of-network repricing and related deadlines.
• Proven KPI-driven management systems, redesigned workflows and scalable ops.
• Experience guiding cross-functional teams through tech deployments.
• Strong financial acumen in forecasting, staffing and cost control.

Responsibilities

• Manage NSA disputes before IDR with deadlines, docs, outcomes and handoffs.
• Own end-to-end IDR operations: intake, case matching, milestones, decisions.
• Lead negotiations and resolution of appeals for out-of-network repricing.
• Oversee Provider Data Management, data quality and automation opportunities.
• Lead Client Services with clear SLAs, ownership and escalation.
• Oversee Medicaid repricing operations for Kaiser account.

Skills

Strategic leadership

Operational leadership

Executive communication

Cross-functional collaboration

Financial acumen

Education

Bachelor's degree or equivalent experience

Advanced degree desirable

Tools

AI-assisted document processing

Workflow orchestration

IDR/process tooling

Job description

Reliant Health Partners is an innovative medical claims repricing service provider, helping employers achieve maximum health plan savings with minimum noise. We tailor our services to each client's needs, providing everything from individual specialty claims repricing, to full plan replacement as a high-performance, open-access network alternative. 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.

Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role.Pay Transparency$170,000—$190,000 USDBenefits:

Benefits:

• Comprehensive medical, dental, vision, and life insurance coverage
• 401(k) retirement plan with employer match
• Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
• Paid time off (PTO) and disability leave
• Employee Assistance Program (EAP)

Equal Employment Opportunity :

At Reliant, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Reliant Health Partners is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.