Sr. Data Quality Analyst, PDM

Alignment Health•Remote CA Outside Bay Area, CA

2d•$98,550 - $147,825

About The Position

The Sr. Data Quality Analyst, PDM leads strategic and operational initiatives to improve the quality, accuracy, integrity, and governance of provider data across Alignment Health. The role partners with Provider Operations, Credentialing, Network Management, Provider Enrollment, Claims, Digital, Compliance, Product, and Technology to ensure provider data is accurate, compliant, and represented consistently across internal and external systems. Serving as a subject matter expert in provider data management and provider directory operations, this position drives data quality programs, root cause analysis, governance practices, monitoring frameworks, and corrective action plans. These efforts improve provider directory accuracy and member and provider experience while reducing operational and regulatory risk. The role combines business process expertise, data analysis, governance leadership, and operational consulting to establish sustainable data quality processes and support provider data transformation initiatives.

Requirements

At least 5 years of experience in healthcare provider operations, provider data management, provider enrollment, credentialing, network operations, or related functions.
At least 3 years of experience leading data quality, data governance, or data integrity initiatives.
Experience supporting provider directory operations and provider data management processes.
Experience conducting root cause analysis and developing corrective action plans.
Strong knowledge of healthcare provider lifecycle processes and provider master data.
Proficiency in Excel, Power BI, and SQL, including analyzing provider data, identifying quality issues, and developing reports and dashboards.
Experience with Tableau or a similar data visualization tool.
Ability to work Pacific Time (PST/PDT) business hours.
Bachelor's degree in Business Administration, Healthcare Administration, Information Management, Data Analytics, Health Informatics, or a related field; an equivalent combination of education and experience may be considered.
Deep understanding of provider operations, provider data management, and provider directory processes.
Knowledge of provider credentialing, enrollment, contracting, and network management workflows.
Advanced Excel skills and proficiency with Power BI and SQL for provider data analysis, reporting, and visualization.
Ability to analyze large provider datasets, identify data integrity issues, and translate findings into actionable recommendations.
Strong analytical, problem-solving, and critical-thinking skills.
Ability to translate complex data issues into business recommendations and operational actions.
Experience developing KPIs, scorecards, dashboards, and quality monitoring frameworks.
Strong communication and presentation skills, with the ability to influence stakeholders at all levels.
Ability to manage competing priorities and drive results in a fast-paced environment.
Advanced proficiency with data analysis and reporting tools.

Nice To Haves

Experience with Quest Analytics, particularly Network Adequacy analysis, monitoring, and reporting.
Experience within a health plan or managed care environment.
Experience supporting CMS, NCQA, accreditation, or regulatory compliance activities.
Experience working with provider lifecycle management platforms and provider data repositories.
Experience supporting data governance or master data management programs.
Experience with quality improvement methodologies and operational transformation initiatives.

Responsibilities

Lead provider data quality initiatives across contracting, credentialing, enrollment, maintenance, and termination processes.
Develop and maintain data quality frameworks, standards, controls, and key performance indicators.
Identify provider data quality issues through analytics, audits, monitoring, and stakeholder feedback.
Perform root cause analysis of provider data defects and recommend corrective and preventive actions.
Establish quality assurance and validation processes to improve provider record accuracy.
Drive remediation of provider data discrepancies and systemic issues.
Support provider directory accuracy programs designed to meet regulatory and accreditation requirements.
Monitor directory performance metrics and identify trends affecting member and provider experience.
Partner with Compliance on CMS, state, NCQA, and accreditation-related directory requirements.
Design and implement controls to improve provider directory accuracy and reduce regulatory risk.
Support readiness activities, audits, corrective action plans, and regulatory reporting.
Serve as a business lead for provider data governance initiatives.
Define and maintain provider data definitions, business rules, standards, and stewardship responsibilities.
Partner with business and technology teams to establish provider master data governance processes.
Facilitate governance forums and stakeholder discussions about data ownership, accountability, and quality improvement.
Support development of policies, procedures, and operating models for provider data management.
Analyze provider data across source systems to identify quality issues, trends, gaps, and opportunities.
Develop dashboards and reports that show data quality performance and operational effectiveness.
Measure the impact of data quality initiatives using established metrics and business outcomes.
Present findings, recommendations, and progress updates to leadership and cross-functional stakeholders.
Assess end-to-end provider operational processes and identify opportunities to improve accuracy and efficiency.
Lead continuous improvement initiatives using structured problem-solving methodologies.
Document current- and future-state workflows for provider data management and directory operations.
Partner with operational teams to implement sustainable process improvements.
Support automation and technology solutions that improve data quality, governance, and operational effectiveness.
Collaborate with Network Management, Credentialing, Provider Enrollment, Claims, Digital, Product, Compliance, and Technology teams.
Advise on provider data initiatives and enterprise transformation efforts.
Support strategic projects involving provider data modernization, provider lifecycle management, and directory optimization.
Facilitate stakeholder alignment and resolve cross-functional data quality issues.
Perform other duties as assigned by the manager.