AVP, Encounters Data Strategy & Revenue Integrity

Alignment Health; United States; À distance; USD 198 000 - 297 000; Plein temps

Résumé du poste

Alignment Health is seeking an Associate Vice President of Encounters to lead the encounter data function, ensure complete and timely CMS submissions, and drive remediation across delegated and capitated provider groups. The role requires deep expertise in Medicare Advantage data operations and a proven ability to lead cross-functional teams toward improved data quality and revenue integrity.

The AVP will own governance, performance, and escalation strategies, partnering with Risk Adjustment

Qualifications

• Bachelor’s degree in business, healthcare administration, information systems, finance, or a related field.
• Experience with Part C EDPS submission, the 837 lifecycle, CMS response files, and error correction and resubmission.
• Experience with MAO-004 reconciliation and closing gaps between submitted, accepted, and stored data.
• Experience collecting and remediating encounter data from delegated or capitated provider groups.
• Executive communication skills; ability to translate data problems for executives and providers.

Responsabilités

• Build the Encounters function: design the operating model, governance, and performance routines.
• Lead submission operations, data quality, reconciliation, analytics, and delegated-entity performance teams.
• Oversee Part C submissions through EDPS and Part D PDE submission with governance and risk controls.
• Establish governance for chart review, data submissions, and source data remediation.
• Partner with Risk Adjustment to align data quality with revenue opportunities and forecasts.

Connaissances

Executive communication

Leadership

Builder

Technical mindset

Operational rigor

Financial acumen

Influence

Root-cause orientation

Formation

Bachelor’s degree (business | healthcare administration | information systems | finance)

Master’s degree

Outils

Facets

Description du poste

Alignment Health is seeking an Associate Vice President of Encounters to lead the encounter data function, ensure complete and timely CMS submissions, and drive remediation across delegated and capitated provider groups. The role requires deep expertise in Medicare Advantage data operations and a proven ability to lead cross-functional teams toward improved data quality and revenue integrity.

The AVP will own governance, performance, and escalation strategies, partnering with Risk Adjustment