Associate Vice President, Encounters at Alignment Healthcare in Orange, CA

Job description

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 Associate Vice President, Encounters leads Alignment Health's encounter data function and is accountable for the strategy, operating model, controls, and performance required to deliver complete, accurate, and timely Part C and Part D submissions to CMS, effective reconciliation and remediation, and reliable encounter data capture from delegated and capitated provider groups. Reporting to the Senior Vice President, Claims & Payment Integrity, the AVP translates the broader Claims & Payment Integrity strategy into encounter-specific priorities and leads cross-functional accountability across Claims Operations, Configuration, Technology, Compliance, Finance, Network Management, and delegated oversight so systemic defects are corrected at the source rather than managed at submission. The AVP serves as the senior functional leader for encounter data and partners closely with Risk Adjustment, which retains ownership of clinical documentation strategy. The AVP owns encounter data governance, submission performance, control effectiveness, and the identification and escalation of revenue and compliance exposure, while recommending capability, technology, and resource investments to the SVP. This builder must lead through managers and specialized teams while maintaining strong technical, regulatory, and financial acumen. Job Duties/Responsibilities: Build the Encounters Function · Design and lead the Encounters operating model, including organizational structure, decision rights, governance, control standards, performance routines, and escalation protocols, in alignment with the broader Claims & Payment Integrity strategy. · Develop and execute the approved capability roadmap for the Encounters function, recommending the appropriate mix of internal talent, technology, processes, and vendor support to improve control, scalability, and cost effectiveness. · Establish the encounter performance and risk framework, including submission completeness and timeliness, acceptance and rejection trends, reconciliation status, control effectiveness, delegated-entity performance, and revenue or compliance exposure. · Build and lead a high-performing organization through accountable managers and specialized teams spanning submission operations, data quality, reconciliation, analytics, and delegated-entity performance; develop leadership capability and succession depth. Encounter Data Submission & Operations · Provide executive oversight and functional accountability for Part C encounter submissions through EDPS, ensuring the 837 institutional and professional lifecycle, rejection remediation, resubmission processes, and supporting controls meet CMS requirements and approved performance standards. · Establish governance and shared accountability with the pharmacy organization and PBM for Part D prescription drug event submission, reconciliation, error resolution, and timely escalation of material performance or compliance risk. · Ensure disciplined MAO-002 and MAO-004 reconciliation through management controls that identify, prioritize, and remediate material variances between submitted, accepted, stored, and risk-adjustment-eligible data. · Establish governance and control standards for chart review and supplemental data submissions, including adds and deletes, to ensure submissions are accurate, supported, trace