Alignment Healthcare-posted 8 months ago
$130,332 - $195,498/Yr
Full-time • Senior
Remote • Portage, IN
Professional, Scientific, and Technical Services

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 Senior Manager, Provider Data - Medicare Advantage is responsible for overseeing and optimizing the integrity, accuracy, and compliance of provider data supporting the organization's Medicare Advantage (MA) line of business. This role leads a team dedicated to managing the full provider data lifecycle, ensuring timely updates, CMS-compliant directory submissions, and seamless integration with claims, credentialing, and network management systems. The Senior Manager will collaborate cross-functionally to maintain a high standard of provider data that supports network adequacy, member access, and regulatory readiness.

  • Lead the daily operations of the provider data team supporting Medicare Advantage, including onboarding, demographic updates, terminations, and data reconciliation.
  • Maintain high-quality data workflows to meet CMS requirements for provider directories and network reporting.
  • Coordinate the intake and processing of provider data files from internal sources and delegated entities.
  • Manage team workload, prioritize tasks, and allocate resources to meet operational goals and service levels.
  • Ensure full compliance with CMS requirements for provider directory accuracy, network adequacy submissions, and the No Surprises Act.
  • Manage data audits and support regulatory reviews, including responses to CMS validation requests and state DOI inquiries.
  • Collaborate with Compliance and Quality teams to align operations with Medicare Advantage policies and performance standards.
  • Monitor key data quality indicators including NPI accuracy, taxonomy, specialties, accessibility, and office locations.
  • Implement controls, validations, and automation to ensure data completeness and consistency across platforms.
  • Identify and resolve issues that impact claims processing, member experience, and provider payments.
  • Oversee processes to validate and reconcile provider data from multiple sources (internal, external, third-party).
  • Serve as the provider data point of contact for Medicare-specific stakeholders including Network Operations, Credentialing, Quality/Stars, Claims, and Member Services.
  • Partner with IT to improve provider data systems, automation, and reporting tools.
  • Coordinate with external vendors and delegated groups to ensure data accuracy and timeliness.
  • Lead, coach, and develop a team of provider data analysts, specialists, and coordinators. Establish clear goals, ensure adequate training, and foster a culture of accountability and continuous improvement.
  • 5+ years of experience in healthcare operations, with at least 3 years managing provider data teams in a Medicare Advantage environment.
  • 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.
  • Bachelor's degree in Healthcare Administration, Business, Information Systems, or related field.
  • MBA or MHA
  • 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.
  • 401k
  • health insurance
  • paid holidays
  • flexible scheduling
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