AVP, Encounters Data & Revenue Integrity

Alignment Healthcare USA, LLC; Orange (CA); On-site; USD 198,000 - 297,000; Full time

Job summary

Alignment Health in California is seeking an experienced AVP, Encounters to lead the encounter data function. You will translate strategy into a scalable operating model, oversee Part C submissions through EDPS, and partner with Risk Adjustment to ensure complete, accurate data and timely CMS reporting.

You will manage cross-functional teams across claims operations, data quality, reconciliation, analytics, and delegated-provider performance, driving remediation, governance, and controls while

Qualifications

• 10+ years of progressive leadership in Medicare Advantage encounter data or health plan data operations.
• Proven ability to design and scale an encounters function across submission, data quality, and analytics.
• Strong understanding of CMS EDPS, MAO-002/MAO-004, and risk-adjustment data workflows.
• Excellent executive-level communication and cross-functional collaboration.
• Bachelor's degree required; master's preferred.

Responsibilities

• Lead the Encounters function and governance to ensure complete, timely CMS submissions.
• Oversee Part C and Part D data submission, reconciliation, and remediation.
• Partner with Risk Adjustment and Compliance to identify revenue opportunities and address exposure.
• Build and mentor a high-performing team across operations, data quality, analytics, and delegated performance.
• Drive continuous improvement and control standards to reduce defects at the source.

Skills

Leadership

Strategic thinking

Executive communication

Regulatory data governance

Analytics

Education

Bachelor's degree in business, healthcare administration, information systems, finance, or related field

Master's degree

Tools

Facets

Job description

Alignment Health in California is seeking an experienced AVP, Encounters to lead the encounter data function. You will translate strategy into a scalable operating model, oversee Part C submissions through EDPS, and partner with Risk Adjustment to ensure complete, accurate data and timely CMS reporting.

You will manage cross-functional teams across claims operations, data quality, reconciliation, analytics, and delegated-provider performance, driving remediation, governance, and controls while