AVP, Encounters & Medicare Data Strategy

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

Job summary

Alignment Health in the United States seeks an Associate Vice President, Encounters to lead the Encounters function and ensure complete, accurate CMS Part C/D submissions. You will drive governance, data quality, and reconciliation, partnering with Risk Adjustment and cross-functional teams to optimize revenue integrity and compliance while guiding a high-performing, scalable operation.

The role requires executive communication, strategic leadership, and deep knowledge of Part C EDPS, PDE, and

Qualifications

• Bachelor's degree in business, healthcare administration, information systems, finance, or a related field is required.
• Master's degree is preferred.
• Experience leading encounter data submissions, reconciliation, and risk-adjusted revenue programs.
• Executive-level communication skills to translate complex data to executives and providers.

Responsibilities

• Design and lead the Encounters function and operating model, including governance, performance routines, and escalation protocols.
• Oversee Part C/D encounter submissions through EDPS and ensure CMS requirements and performance standards are met.
• Set strategy for data from delegated and capitated provider groups and establish remediation and escalation for data quality issues.
• Define the encounter data quality framework, data lineage, and root-cause remediation with cross-functional teams.
• Partner with Risk Adjustment to align revenue opportunities with compliant program targeting.

Skills

Functional design

Financial acumen

Root-cause analysis

Influence / leadership

Encounter data fluency

EDI transactions

Reconciliation logic

Executive communication

Education

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

Master's degree

Tools

Facets or equivalent core claims platform

Job description

Alignment Health in the United States seeks an Associate Vice President, Encounters to lead the Encounters function and ensure complete, accurate CMS Part C/D submissions. You will drive governance, data quality, and reconciliation, partnering with Risk Adjustment and cross-functional teams to optimize revenue integrity and compliance while guiding a high-performing, scalable operation.

The role requires executive communication, strategic leadership, and deep knowledge of Part C EDPS, PDE, and