Director, ACO Operations

Pearl Health

4d•$150,000 - $195,000

About The Position

You will step into a high-stakes, mission-critical role where you own the operational engine that allows Pearl Health to scale its impact on value-based care. By mastering the complexities of CMS provider submissions and ACO operations, you will directly safeguard the integrity of our networks and enable compliant operations and access to enhanced benefits for our members. This is an invitation to build operational resilience from the ground up, transitioning a vital function from a "heroic effort" to a sustainable, best-in-class program that scales with our growth. Who We Are Pearl Health is dedicated to empowering primary care providers, health systems, and physician-led networks to succeed in the shift to value-based care. Our platform delivers the technology, financial tools, and expert services that enable practices to provide more proactive, effective care to their Medicare patients, ultimately lowering costs and improving health outcomes. Founded in 2020, we are a team of healthcare and technology innovators backed by premier investors like Andreessen Horowitz, Viking Global Investors, and AlleyCorp. We partner with thousands of providers across 44 states to build a more sustainable future for American healthcare. What You'll Do As the Director of ACO Operations, you will be the primary architect and executor of our CMS Program Operations, ensuring every roster submission and regulatory requirement is met with precision. You will bridge the gap between tactical execution and strategic program ownership to ensure our ACOs remain compliant.

Requirements

Orchestrate complex, multi-phase project lifecycles, ensuring seamless delivery within high-pressure environments and rigid deadlines.
Maintain a zero-margin-for-error standard while overseeing the ingestion and processing of high-volume, mission-critical data sets.
Proactively identify and resolve bottlenecks in data-intensive workflows to prevent downstream inaccuracies.
Deep technical knowledge of value-based care programs (eg. ACO REACH and/or MSSP) and regulations, with the ability to translate complex CMS guidelines into actionable project plans.
Accountability for regulatory deadlines, with a proven track record of meeting multi-stakeholder filing requirements without constant oversight.

Nice To Haves

Direct experience with CMS provider submissions, having successfully managed at least one full roster cycle for an ACO or similar value-based care entity.
Experience implementing or managing a Roster Management System (RMS) or similar tool used to automate provider data flows.
Background in CMS program management or policy, particularly experience with BEI programs and compliance frameworks.
Prior leadership in a high-growth startup environment, where you have successfully transitioned tactical "sprint" work into repeatable programmatic systems.

Responsibilities

Lead the end-to-end Provider Submission process, serving as the accountable leader for roster accuracy and CMS deadlines during critical windows.
Manage the Roster Management System (RMS) workflow, overseeing the transition of provider data into a streamlined, automated submission process.
Provide strategic oversight and execution of Beneficiary Enhancement (BE) and Beneficiary Engagement Incentive (BEI) programs, ensuring all BE/BEI filings are accurate and compliant with CMS standards.
Direct the development of educational materials and training programs for internal Pearl employees to socialize complex ACO regulatory requirements.
Oversee mandatory CMS operational tasks, including CEHRT compliance, MSSP applications, and the coordination of beneficiary notification letters.
Responsible for CMS-related knowledge management and partnership with the Program Owner and SMEs to modernize our program operations, documenting processes to eliminate "sausage-making" during peak cycles.
Manage external resources and contractors during high-volume periods to maintain high quality-control standards under tight regulatory pressure.