AVP, Encounters Data & CMS Submissions

E2E Alignment Healthcare USA, LLC; California; On-site; USD 198,000 - 297,000; Full time

Job summary

Alignment Health is seeking an Associate Vice President, Encounters to lead the encounter data function, ensuring complete and timely CMS Part C and Part D submissions with accurate reconciliations. The AVP will drive governance, controls, and cross-functional accountability across Claims Operations, Technology, Compliance, Finance, and Risk Adjustment.

This senior role requires 10+ years in Medicare Advantage encounter data or related data operations, including 5+ years in leadership, with

Qualifications

• 10+ years in Medicare Advantage encounter data or healthcare data operations.
• Experience leading teams in health-plan environments.
• Deep knowledge of Part C EDPS submission and CMS responses.
• Executive-level communication of technical data to leaders.

Responsibilities

• Build and lead the Encounters Function across submission operations and data quality.
• Design an Encounters operating model with governance and escalation protocols.
• Develop capability roadmap for Encounters to improve control and cost efficiency.
• Provide oversight for Part C and Part D submissions and reconciliations.
• Establish data quality framework, controls, and performance reporting.

Skills

Encounter data experience

Executive leadership

CMS systems

Data reconciliation

Regulatory knowledge

Education

Bachelor's degree

Master's degree

Tools

EDPS

Facets

CMS tooling

Job description

Alignment Health is seeking an Associate Vice President, Encounters to lead the encounter data function, ensuring complete and timely CMS Part C and Part D submissions with accurate reconciliations. The AVP will drive governance, controls, and cross-functional accountability across Claims Operations, Technology, Compliance, Finance, and Risk Adjustment.

This senior role requires 10+ years in Medicare Advantage encounter data or related data operations, including 5+ years in leadership, with