Associate Vice President, Encounters Remote (anywhere in United States) + 1 more

The Company is seeking an Associate Vice President for Encounters to lead the strategic and operational aspects of encounter data, with a strong focus on Medicare Advantage. The successful candidate will be responsible for the design and implementation of the encounters operating model, ensuring the delivery of complete, accurate, and timely Part C and Part D submissions to CMS. This role requires a builder with a technical mindset, operational rigor, and a root-cause orientation, capable of leading a high-performing organization and driving continuous improvement. The AVP will also be accountable for encounter data governance, submission performance, and the identification and escalation of revenue and compliance exposure. Applicants must have a minimum of 10 years' experience in Medicare Advantage encounter data, claims operations, or healthcare data operations, with at least 5 years in a leadership role. A deep understanding of Part C EDPS submission, the 837 lifecycle, and MAO-004 reconciliation is essential. The role demands executive-level communication skills, the ability to influence and hold partners accountable, and a strong partnership with the Risk Adjustment organization. A Bachelor's degree in a relevant field is required, with a preference for a Master's degree. The ideal candidate will have a proven track record of improving acceptance rates, clearing rejection backlogs, and recovering revenue, as well as experience in building an encounters function and insourcing operations.

Hiring Company

Alignment Health