Associate Vice President of Encounters

Job Summary

Leading the encounter data function, the full-time Associate Vice President of Encounters will manage strategy, operating models, and performance metrics to ensure accurate and timely Part C and Part D submissions to CMS while working remotely.

Key responsibilities

• Design and implement the Encounters operating model, including governance and performance standards
• Oversee Part C and Part D encounter submissions, ensuring compliance with CMS requirements and effective reconciliation processes
• Establish and govern a framework for encounter data quality, focusing on root-cause remediation and cross-functional accountability

Required qualifications

• 10+ years of experience in Medicare Advantage encounter data or healthcare data operations, with 5+ years in leadership roles
• Health plan experience with direct ownership of encounter data submission
• In-depth knowledge of Part C EDPS submission and MAO-004 reconciliation processes
• Proven track record of improving acceptance rates and managing rejection backlogs
• Bachelor's degree in business, healthcare administration, information systems, finance, or a related field