Manager, Clinical Data Management

Aledade PBC

19h • Remote

About The Position

The Manager, Clinical Data Management is responsible for the full lifecycle of the organization’s Encounter Data Submission and Reconciliation strategy. The role ensures diagnoses are accurately tracked, submitted, and accepted by payers and CMS, translating clinical documentation into reliable, compliant, and financially meaningful data. The manager works across internal teams, vendors, and payers to identify gaps, resolve root causes, and continuously improve encounter data submission and reconciliation.

The role oversees end-to-end submission strategy, priorities, and operations; creates and transmits ASM files; establishes diagnosis reconciliation processes; and leads corrective action for rejected or dropped diagnoses. It also supports retrospective chart review strategy, monitors quality and compliance, develops process documentation, and identifies ways to improve acceptance rates and financial performance.

The manager leads cross-functional initiatives, integrates accepted submitted diagnosis data into risk reporting, develops recurring leadership reports, and owns ASM valuation and financial results in partnership with Data and Analytics. Aledade PBC is a public benefit corporation focused on empowering independent primary care and advancing value-based care. The company describes its culture as collaborative, inclusive, and remote-first.

Requirements

• Bachelor’s degree in Business, Finance, IT, Healthcare Analytics, or Operations.
• At least 6 years of experience with Medicare Advantage or ACA encounter data processes and/or risk adjustment experience within a payer, vendor, or Value Based Care organization.
• At least 3 years of program or project management experience, including ownership of complex, multi-stakeholder initiatives.
• At least 2 years of working knowledge of X12 837 transaction sets.
• Working knowledge of CMS EDPS experience, including MAO-002 and MAO-004 reports.
• Strong analytical capabilities and demonstrated ability to interpret complex datasets and synthesize actionable insights.
• Excellent written and verbal communication skills, with experience developing and presenting key information to executive leadership.
• Working knowledge of SQL, including writing, modifying, and executing queries.
• Proficiency in Google Workspace, project tracking software such as Jira or Smartsheet, and business intelligence or dashboard platforms.

Nice To Haves

• Familiarity with Business Process Reengineering (BPR) principles and methodologies to optimize processes for efficiency and performance.
• Experience with chart selection or targeting strategies for retrospective chart review.
• Fundamental understanding of relational databases.

Responsibilities

• Oversee end-to-end strategy, priorities, and operations for accurate and compliant encounter data submission to payers and CMS.
• Create and transmit ASM files on established cadences, maintaining payer-specific templates and submission methods annually.
• Establish routine reconciliation processes that track diagnoses from documentation through acceptance, quantify gaps, and identify dropped or truncated records early.
• Lead root-cause analysis and corrective action across internal teams, vendors, and payers for rejected or dropped diagnoses.
• Partner with operations leadership on strategy, chart selection, and annual evaluation for retrospective chart review initiatives.
• Monitor submission metrics and acceptance rates, applying data scrubs and business rules to meet regulatory standards and CMS and payer deadlines.
• Collaborate with leadership and legal partners to ensure compliance in add and delete diagnosis workflows.
• Develop and maintain process documentation, SOPs, and routine workflow updates.
• Identify tools and long-term strategies to improve encounter acceptance rates, minimize manual effort, and expand ASM processes across eligible payers.
• Evaluate annual ROI across submission and audit processes and optimize workflows to drive financial performance.
• Lead cross-functional initiatives with key stakeholders to resolve data flow issues and implement system updates.
• Integrate accepted ASM-submitted diagnosis data into existing risk reporting dashboards and build recurring reports for leadership.
• Own ASM valuation and financial results, partnering with Data and Analytics on metric definitions and data quality.
• Perform other duties as assigned.

Benefits

• Flexible work schedules and remote work availability for many roles.
• Health, dental, and vision insurance paid up to 80% for employees, dependents, and domestic partners.
• Robust time-off plan, including 21 days of PTO in the first year.
• Two paid volunteer days and 11 paid holidays.
• 12 weeks of paid parental leave for all new parents.
• Six weeks of paid sabbatical after six years of service.
• Educational Assistant Program and Clinical Employee Reimbursement Program.
• 401(k) with up to 4% match.
• Stock options.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager