Vice President, Administration

TruHealth • Franklin, TN

6h

About The Position

To perform this job, an individual must accomplish each essential function
satisfactorily, with or without a reasonable accommodation.

Administrative duties include:

Responsible for oversight of first tier downstream vendors to ensure daily
operations, reporting and systems meet CMS Medicare Advantage rules and
regulations
Partner with senior leaders in the organization to drive cross-departmental
efficiency and continuous process
Operationalize innovative benefits, programs and medical cost-reduction
Collaborate with Compliance for Department of Insurance or CMS complaint
review, response and
Drive operational effectiveness to ensure quality and accuracy of work
outcomes based on regulatory, contractual and/or company commitments.
Lead, develop, recruit and retain a highly efficient and effective team of
great
Establish a strong emphasis on high-quality, efficient and effective
processes related to support
Ensure policies, procedures and internal controls are developed and
Serve as the primary executive point of contact for the company’s claims
vendor.
Oversee TPA performance, SLAs, operational controls and contract compliance.
Lead escalation management, root-cause analysis and corrective action
planning.
Conduct regular business reviews, performance assessments and strategic
alignment sessions with TPA leadership.
Provide leadership and director to the Claims, Provider Data and
Credentialing Teams.
Lead internal claims operations and ensure timely, accurate claims processing
in alignment with CMS, state and organizational standards.
Maintain oversight of claims payment integrity, configuration updates,
adjudication workflows and issue resolution.
Partner with Finance, Compliance and Actuarial teams to support audit
readiness, reporting and claims data accuracy.
Oversee all provider data management functions, ensuring data completeness,
accuracy and timely updates across systems.
Ensure credentialing activities meet CMS, NCQA and state regulatory
requirements, including credentialing, re-credentialing, and delegation
oversight.
Collaborate with Network Development teams to support onboarding, contracting
and provider directory integrity.
Develop and execute administrative operational strategies aligned with
organizational growth and performance goals.
Support system implementations, data migrations, and operational readiness
for new states, contracts or product offerings.
Provide executive-level reporting to senior leadership and the Board as
required.

Requirements

• Bachelor’s degree in Business Administration or related field
• At least five (5) years of experience in health plan administration/managed care, preferably within Medicare Advantage
• At least five (5) years of experience in healthcare analytics

Responsibilities

• Responsible for oversight of first tier downstream vendors to ensure daily operations, reporting and systems meet CMS Medicare Advantage rules and regulations
• Partner with senior leaders in the organization to drive cross-departmental efficiency and continuous process
• Operationalize innovative benefits, programs and medical cost-reduction
• Collaborate with Compliance for Department of Insurance or CMS complaint review, response and
• Drive operational effectiveness to ensure quality and accuracy of work outcomes based on regulatory, contractual and/or company commitments.
• Lead, develop, recruit and retain a highly efficient and effective team of great
• Establish a strong emphasis on high-quality, efficient and effective processes related to support
• Ensure policies, procedures and internal controls are developed and
• Serve as the primary executive point of contact for the company’s claims vendor.
• Oversee TPA performance, SLAs, operational controls and contract compliance.
• Lead escalation management, root-cause analysis and corrective action planning.
• Conduct regular business reviews, performance assessments and strategic alignment sessions with TPA leadership.
• Provide leadership and director to the Claims, Provider Data and Credentialing Teams.
• Lead internal claims operations and ensure timely, accurate claims processing in alignment with CMS, state and organizational standards.
• Maintain oversight of claims payment integrity, configuration updates, adjudication workflows and issue resolution.
• Partner with Finance, Compliance and Actuarial teams to support audit readiness, reporting and claims data accuracy.
• Oversee all provider data management functions, ensuring data completeness, accuracy and timely updates across systems.
• Ensure credentialing activities meet CMS, NCQA and state regulatory requirements, including credentialing, re-credentialing, and delegation oversight.
• Collaborate with Network Development teams to support onboarding, contracting and provider directory integrity.
• Develop and execute administrative operational strategies aligned with organizational growth and performance goals.
• Support system implementations, data migrations, and operational readiness for new states, contracts or product offerings.
• Provide executive-level reporting to senior leadership and the Board as required.

What This Job Offers

• Career Level: Executive
• Number of Employees: 11-50 employees