VP, Provider Data Management

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 VP, Provider Data will lead the strategic development, implementation, and optimization of the provider data infrastructure, ensuring the creation and maintenance of a robust provider data model. This role is critical in establishing a unified, accurate, and compliant provider data ecosystem that supports operational efficiency, regulatory adherence, and enhanced provider and member experiences. The AVP, Provider Data will serve as a key leader in driving innovation, standardization, and strategic integration of provider data across all platforms and business functions.

Job Duties/Responsibilities: 

• Provider Data Model Development & Oversight 

• Design & Implementation: Lead the design and implementation of a comprehensive provider data model that encompasses provider identities, affiliations, specialties, credentials, and network participation. 

• Standardization & Integration: Establish standardized data formats and definitions to ensure consistency across all provider data systems.  

• Data Governance: Develop and enforce data governance policies and procedures to maintain the integrity and accuracy of provider data throughout its lifecycle. 

• Infrastructure Development & Optimization 

• System Architecture: Collaborate with data architecture team on the architecture of provider data systems, ensuring scalability, flexibility, and alignment with organizational goals. 

• Data Flow Management: Manage the ingestion, transformation, and distribution of provider data across various systems, ensuring real-time access and synchronization. 

• Optimization: Collaborate with stakeholders to continuously improve provider data processes with focus on automation and quality management.  

• Technology Integration: Collaborate with IT and data architecture teams to integrate provider data systems with core administrative processing systems, credentialing platforms, claims system, and provider directories. 

• Compliance & Regulatory Adherence 

• Regulatory Compliance: Ensure provider data systems comply with federal and state regulations, including HIPAA, the No Surprises Act, and URAC standards. 

• Audit & Reporting: Oversee the preparation and submission of provider data reports for regulatory audits, ensuring accuracy and timeliness. 

• Quality Management 

• Quality Assurance: Implement quality assurance processes to monitor and maintain the accuracy and completeness of provider data, addressing discrepancies proactively. Implement controls, validations, and automation to ensure data completeness and consistency across platforms. 

• Quality Monitoring: Monitor key data quality indicators including NPI accuracy, taxonomy, specialties, accessibility, and office locations. 

• Cross-Functional Collaboration 

• Stakeholder Engagement: Collaborate with internal stakeholders, including credentialing, network management, IT, and compliance teams, to ensure alignment and support for provider data initiatives. 

• External Partnerships: Engage with external vendors and third-party data providers to enhance data acquisition, validation, and enrichment efforts. 

• Training & Support: Provide training and support to internal teams on provider data systems, policies, and best practices. 

• Strategic Planning & Execution 

• Roadmap Development: Develop and execute a strategic roadmap for provider data infrastructure enhancements, aligning with business objectives and regulatory requirements. 

• Innovation & Improvement: Monitor industry trends and emerging technologies to identify opportunities for innovation and improvement in provider data management. 

• Change Management: Lead change management efforts related to provider data initiatives, ensuring successful adoption and integration across the organization. 

 

Job Requirements: 

Experience: 

Required:  

• 8+ years of progressive leadership experience in provider data management, healthcare data strategy, or enterprise data governance with at least 5 years of experience in a leadership role 

• Proven experience in developing and optimizing provider data infrastructure including system design, data integration, and process improvement. 

• 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:  

• Strong understanding of provider data governance, data quality, and data integration processes. 

• Proficiency in data management tools and platforms, including cloud-based solutions. 

• 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: $198,219.00 - $297,329.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

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 email careers@ahcusa.com.