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 Sr. Data Quality Analyst, PDM is responsible for leading strategic and operational initiatives that improve the quality, accuracy, integrity, and governance of provider data across the organization. This role partners closely with Provider Operations, Credentialing, Network Management, Provider Enrollment, Claims, Digital, Compliance, Product, and Technology teams to ensure provider data is accurate, compliant, and consistently represented across all internal and external systems.
This role serves as a subject matter expert in provider data management and provider directory operations, driving data quality programs, root cause analysis, governance practices, monitoring frameworks, and corrective action plans that improve provider directory accuracy and member/provider experience while reducing operational and regulatory risk.
This position combines business process expertise, data analysis, governance leadership, and operational consulting to establish sustainable data quality processes and support provider data transformation initiatives.
Job Duties/Responsibilities:
Provider Data Quality & Integrity
- Lead provider data quality initiatives across provider lifecycle management processes, including contracting, credentialing, enrollment, maintenance, and termination activities.
- Develop and maintain data quality frameworks, standards, controls, and key performance indicators (KPIs).
- Identify 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 ongoing quality assurance and validation processes to improve provider record accuracy.
- Drive remediation efforts for identifying provider data discrepancies and systemic issues.
Provider Directory Accuracy & Regulatory Compliance
- Support enterprise provider directory accuracy programs designed to meet regulatory and accreditation requirements.
- Monitor directory performance metrics and identify trends impacting member and provider experience.
- Partner with compliance teams to support CMS, state, NCQA, and accreditation-related directory requirements.
- Design and implement controls that improve provider directory accuracy and reduce regulatory risk.
- Support readiness activities, audits, corrective action plans, and regulatory reporting.
Data Governance
- 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 governance processes for provider master data.
- Facilitate governance forums and stakeholder discussions focused on data ownership, accountability, and quality improvement.
- Support the development of policies, procedures, and operating models related to provider data management.
Data Analysis & Reporting
- Analyze provider data across multiple source systems to identify quality issues, trends, gaps, and opportunities.
- Develop dashboards and reporting solutions that provide visibility into data quality performance and operational effectiveness.
- Measure the impact of data quality initiatives through established metrics and business outcomes.
- Present findings, recommendations, and progress updates to leadership and cross-functional stakeholders.
Process Improvement & Operational Excellence
- Assess end-to-end provider operational processes and identify opportunities to improve data accuracy and operational efficiency.
- Lead continuous improvement initiatives using structured problem-solving methodologies.
- Document current-state and future-state workflows related to 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.
Cross-Functional Collaboration
- Collaborate with Network Management, Credentialing, Provider Enrollment, Claims, Digital, Product, Compliance, and Technology teams.
- Serve as a trusted advisor on provider data-related initiatives and enterprise transformation efforts.
- Support strategic projects involving provider data modernization, provider lifecycle management, and directory optimization.
- Facilitate stakeholder alignment and drive resolution of cross-functional data quality issues.
- Other duties as assigned by your manager.
Job Requirements:
EXPERIENCE
Required:
- 5+ years of experience in healthcare provider operations, provider data management, provider enrollment, credentialing, network operations, or related functions.
- 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, with experience analyzing provider data, identifying data quality issues, and developing reports and dashboards.
- Experience with Tableau or similar data visualization tool
- Must be able to work Pacific Time (PST/PDT) business hours
Preferred:
- 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.
EDUCATION
- Required: Bachelor's degree in Business Administration, Healthcare Administration, Information Management, Data Analytics, Health Informatics, or related field.
- Equivalent combination of education and experience may be considered.
SPECIALIZED SKILLS
- 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.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Employment sponsorship is not available for this position
Pay Range: $98,550.00 - $147,825.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.
