VP, Provider Data Management

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 VP, Provider Data will lead the strategic development, implementation, and optimization of the provider data infrastructure, ensuring the creation and maintenance of a robust provider data model. This role is critical in establishing a unified, accurate, and compliant provider data ecosystem that supports operational efficiency, regulatory adherence, and enhanced provider and member experiences. The AVP, Provider Data will serve as a key leader in driving innovation, standardization, and strategic integration of provider data across all platforms and business functions.

Job Duties/Responsibilities: 

• Provider Data Model Development & Oversight 

• Design & Implementation: Lead the design and implementation of a comprehensive provider data model that encompasses provider identities, affiliations, specialties, credentials, and network participation. 

• Standardization & Integration: Establish standardized data formats and definitions to ensure consistency across all provider data systems.  

• Data Governance: Develop and enforce data governance policies and procedures to maintain the integrity and accuracy of provider data throughout its lifecycle. 

• Infrastructure Development & Optimization 

• System Architecture: Collaborate with data architecture team on the architecture of provider data systems, ensuring scalability, flexibility, and alignment with organizational goals. 

• Data Flow Management: Manage the ingestion, transformation, and distribution of provider data across various systems, ensuring real-time access and synchronization. 

• Optimization: Collaborate with stakeholders to continuously improve provider data processes with focus on automation and quality management.  

• Technology Integration: Collaborate with IT and data architecture teams to integrate provider data systems with core administrative processing systems, credentialing platforms, claims system, and provider directories. 

• Compliance & Regulatory Adherence 

• Regulatory Compliance: Ensure provider data systems comply with federal and state regulations, including HIPAA, the No Surprises Act, and URAC standards. 

• Audit & Reporting: Oversee the preparation and submission of provider data reports for regulatory audits, ensuring accuracy and timeliness. 

• Quality Management 

• Quality Assurance: Implement quality assurance processes to monitor and maintain the accuracy and completeness of provider data, addressing discrepancies proactively. Implement controls, validations, and automation to ensure data completeness and consistency across platforms. 

• Quality Monitoring: Monitor key data quality indicators including NPI accuracy, taxonomy, specialties, accessibility, and office locations. 

• Cross-Functional Collaboration 

• Stakeholder Engagement: Collaborate with internal stakeholders, includ