Senior Manager, Provider Data

Alignment Healthcare LLC; Massachusetts; Remote; USD 130,000 - 196,000; Full time

Job summary

An established industry player is seeking a Senior Manager for Provider Data to lead a dedicated team in optimizing provider data integrity for Medicare Advantage. This role offers the chance to drive compliance with CMS guidelines, enhance data quality, and collaborate cross-functionally to ensure regulatory readiness. Join a passionate team committed to transforming senior care and making a real difference in the lives of the elderly. If you're ready to take on a pivotal leadership role in a fast-growing company, this opportunity is perfect for you.

Qualifications

• 5+ years in healthcare operations with 3+ years managing provider data teams.
• In-depth knowledge of CMS guidelines and provider data accuracy.

Responsibilities

• Lead daily operations of provider data team for Medicare Advantage.
• Ensure compliance with CMS requirements and manage data audits.

Skills

Healthcare Operations

Provider Data Management

CMS Compliance

Leadership Skills

Communication Skills

Problem-Solving Skills

Education

Bachelor’s degree in Healthcare Administration

MBA or MHA

Tools

Facets

HealthEdge

QNXT

Salesforce

Job description

Senior Manager, Provider Data page is loaded

Senior Manager, Provider Data

Apply remote type Fully Remote locations Corporate time type Full time posted on Posted Yesterday job requisition id R514

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Senior Manager, Provider Data – Medicare Advantage is responsible for overseeing and optimizing the integrity, accuracy, and compliance of provider data supporting the organization’s Medicare Advantage (MA) line of business. This role leads a team dedicated to managing the full provider data lifecycle, ensuring timely up-dates, CMS-compliant directory submissions, and seamless integration with claims, credentialing, and network management systems. The Senior Manager will collaborate cross-functionally to maintain a high standard of provider data that supports network adequacy, member access, and regulatory readiness.

Job Duties/Responsibilities:

Operational Oversight

• Lead the daily operations of the provider data team supporting Medicare Advantage, including onboarding, demographic updates, terminations, and data reconciliation.
• Maintain high-quality data workflows to meet CMS requirements for provider directories and network reporting.
• Coordinate the intake and processing of provider data files from internal sources and delegated entities.
• Manage team workload, prioritize tasks, and allocate resources to meet operational goals and service levels.

Regulatory Compliance

• Ensure full compliance with CMS requirements for provider directory accuracy, network adequacy submissions, and the No Surprises Act.
• Manage data audits and support regulatory reviews, including responses to CMS validation requests and state DOI inquiries.
• Collaborate with Compliance and Quality teams to align operations with Medicare Advantage policies and performance standards.

Data Quality Management

• Monitor key data quality indicators including NPI accuracy, taxonomy, specialties, accessibility, and office locations.
• Implement controls, validations, and automation to ensure data completeness and consistency across platforms.
• Identify and resolve issues that impact claims processing, member experience, and provider payments.
• Oversee processes to validate and reconcile provider data from multiple sources (internal, external, third-party).

Cross-Functional Leadership

• Serve as the provider data point of contact for Medicare-specific stakeholders including Network Operations, Credentialing, Quality/Stars, Claims, and Member Services.
• Partner with IT to improve provider data systems, automation, and reporting tools.
• Coordinate with external vendors and delegated groups to ensure data accuracy and timeliness.

Supervisory Responsibilities

Lead, coach, and develop a team of provider data analysts, specialists, and coordinators. Establish clear goals, ensure adequate training, and foster a culture of accountability and continuous improvement. Oversee team performance, workload prioritization, and service level achievement.

Job Requirements:

Experience:

Required:

• 5+ years of experience in healthcare operations, with at least 3 years managing provider data teams in a Medicare Advantage environment.
• In-depth knowledge of CMS guidelines related to provider data, directory accuracy, and network adequacy.
• Hands-on experience with provider data platforms and file exchange processes in an MA context.

Education:

Required: Bachelor’s degree in Healthcare Administration, Business, Information Systems, or related field.

Preferred: MBA or MHA

Specialized Skills:

• Required:
  • Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
  • Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
  • Strong leadership, communication, and problem-solving skills.
  • Proficiency in systems such as Facets, HealthEdge, QNXT, CAQH, NPPES, and Salesforce.
  • Familiarity with CMS compliance, No Surprises Act, and related MA regulatory requirements.
  • Excellent attention to detail and experience working in a highly regulated environment.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $130,332.00 - $195,498.00

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER:Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information.Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company.If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/ . If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please [e-mail] .

About Us

Alignment Health is championing a new path in senior care that empowers members to age well and live their most vibrant lives. Our mission-focused team makes high-quality, low-cost care a reality for members every day. Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most.

We believe that great work comes from people who are inspired to be their best. We've built a team of people who want to make a difference in the lives of the seniors we serve. Come join the team that is changing health care — one person at a time.