[Hiring] Associate Vice President, Encounters @Alignment Health

Role Description

The Associate Vice President, Encounters leads Alignment Health's encounter data function and is accountable for the strategy, operating model, controls, and performance required to deliver complete, accurate, and timely Part C and Part D submissions to CMS, effective reconciliation and remediation, and reliable encounter data capture from delegated and capitated provider groups.

Reporting to the Senior Vice President, Claims & Payment Integrity, the AVP translates the broader Claims & Payment Integrity strategy into encounter-specific priorities and leads cross-functional accountability across Claims Operations, Configuration, Technology, Compliance, Finance, Network Management, and delegated oversight so systemic defects are corrected at the source rather than managed at submission.

The AVP serves as the senior functional leader for encounter data and partners closely with Risk Adjustment, which retains ownership of clinical documentation strategy. The AVP owns encounter data governance, submission performance, control effectiveness, and the identification and escalation of revenue and compliance exposure, while recommending capability, technology, and resource investments to the SVP. This builder must lead through managers and specialized teams while maintaining strong technical, regulatory, and financial acumen.

Qualifications

• 10+ years of progressive experience in Medicare Advantage encounter data, claims operations, or healthcare data operations, including 5+ years leading teams.
• Health plan (payer) experience is required, including direct ownership of encounter data submission inside a payer organization.
• Deep working knowledge of Part C EDPS submission, the 837 lifecycle, CMS response files, and error correction and resubmission.
• Experience with MAO-004 reconciliation and with identifying and closing gaps between submitted, accepted, and stored data.
• Experience collecting and remediating encounter data from delegated or capitated provider groups.
• Demonstrated results improving acceptance rates, clearing rejection backlogs, or recovering revenue tied to unsubmitted or rejected encounters.
• Executive-level communication skills, with the ability to make a technical data problem legible to executives and to providers.

Requirements

• Experience building an encounters function, or insourcing encounter operations previously run by a vendor.
• Part D prescription drug event (PDE) submission and reconciliation experience.
• Experience with chart review and supplemental data submissions, including delete logic.
• Experience with Facets or a comparable core claims administration platform.
• Experience partnering with a Risk Adjustment organization on revenue opportunity identification.

Benefits

• 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.

Essential Physical Functions

• 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.
• 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.