Sr director, provider data management & credentialing

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 Senior Director, Provider Data Management (PDM) & Credentialing is responsible for the strategic leadership, governance, and operational execution of provider data management, credentialing, network configuration support, and provider record integrity across the organization. This role ensures provider data is accurate, complete, compliant, and synchronized across all systems of record while aligning provider information, network relationships, contract identifiers, and reimbursement structures with contractual intent.

The Senior Director serves as the operational owner for the end-to-end provider data lifecycle, including credentialing, network participation management, provider maintenance, data quality oversight, and downstream distribution to claims, provider directory, care management, regulatory reporting, and other critical business functions.

Job Duties/Responsibilities:

• Provider Data Management Strategy & Governance
• Lead the enterprise provider data management function and establish governance frameworks supporting data quality, data stewardship, and operational excellence.
• Ensure provider demographic, credentialing, contracting, participation, reimbursement, and network data are maintained accurately across all source systems and downstream platforms.
• Establish data ownership, controls, audit processes, and policies governing provider information throughout the provider lifecycle.
• Develop and monitor key performance indicators (KPIs), service level agreements (SLAs), and quality metrics related to provider data operations.
• Drive continuous improvement initiatives focused on automation, process optimization, data quality improvement, and operational efficiency.

Source of Truth Management & Data Integrity

• Accountable for maintaining consistency and synchronization across provider systems of record, credentialing platforms, contract management systems, network configuration tools, claims platforms, provider directories, and regulatory reporting solutions.
• Ensure provider records accurately reflect Contract intent, Network participation status, provider-to-network relationships, Contract identifiers, Rate schedule identifiers, Affiliation structures, Tax ID and billing relationships, Facility and practitioner relationships.
• Implement controls that prevent and identify discrepancies between source systems and downstream consumers.
• Lead remediation efforts for data quality issues impacting claims payment accuracy, provider directories, member access, and regulatory compliance.

Credentialing Operations Leadership

• Oversee end-to-end credentialing and recredentialing operations for participating providers and facilities.
• Ensure compliance with NCQA, CMS, state regulatory, accreditation, and organizational requirements.
• Monitor credentialing turnaround times, inventory management, productivity, and quality outcomes.
• Partner with Credentialing Committees, Medical Directors, Compliance, Legal, and Provider Network teams to support provider participation decisions.
• Partner with Delegate vendor oversight on credentialing relationships and vendor performance management where applicable.

Network Configuration & Contract Alignment

• Partner closely with Network Management and Provider Contracting teams to ensure provider data accurately reflects executed contract terms.
• Ensure proper implementation and maintenance of Network relationships, Participation status, Contract assignments, Contract IDs, Rate IDs, Product participation indicators, Geographic service areas.
• Establish oversight processes validating configuration aligns with contractual intent and regulatory requirements.
• Collaborate with re Configuration and Claims teams to minimize payment errors and operational risk related to provider setup and maintenance activities.

Operational Leadership

• Lead teams responsible for provider data maintenance, credentialing operations, provider onboarding, roster management, and provider lifecycle management activities.
• Build scalable operational models that support membership growth, acquisitions, new product launches, and network expansion initiatives.
• Direct workforce planning, organizational development, resource management, performance outcomes, and employee engagement efforts.
• Foster a culture of accountability, quality, transparency, and continuous improvement.

Regulatory Compliance & Risk Management

• Ensure readiness for NCQA, CMS, state regulatory audits, accreditation reviews, and internal compliance assessments.
• Oversee provider directory accuracy and provider data compliance programs.
• Partner with Compliance, Legal, and Internal Audit teams to identify and mitigate operational risks.
• Develop corrective action plans for identified gaps and ensure timely implementation.

Technology & Transformation Leadership

• Partner with business and technology leaders to define future-state provider lifecycle management capabilities.
• Drive modernization initiatives involving provider data platforms, credentialing systems, workflow automation, AI-enabled operational processes, and provider directory solutions.
• Support business case development and vendor evaluations related to provider lifecycle transformation.
• Lead implementation efforts that improve data accuracy, operational efficiency, provider experience, and overall organizational scalability.

Job Requirements:

EXPERIENCE

Required:

• 10+ years of progressive healthcare experience within a health plan environment.
• 7+ years of leadership experience within Provider Operations, Provider Data Management, Network Operations, Credentialing Operations, or related functions.
• Demonstrated experience managing provider data across multiple systems and source-of-truth environments.
• Experience supporting contract implementation, provider network setup, contract IDs, reimbursement structures, and rate schedule management.

Preferred:

• Experience with NCQA accreditation requirements and CMS regulations.
• Experience implementing Provider Lifecycle Management (PLM) platforms.
• Knowledge of provider master data management concepts and data governance frameworks.
• Experience with provider data technologies, workflow automation solutions, and digital transformation initiatives.
• Lean Six Sigma, PMP, or related operational excellence certifications.

EDUCATION

Required:

• Bachelor's degree in Healthcare Administration, Business Administration, Health Informatics, Information Systems, or related field.

Preferred:

• Master's degree in Healthcare Administration, Business Administration, Health Informatics, Information Systems, or related field.

SPECIALIZED SKILLS

Deep understanding of provider lifecycle management processes and health plan operations. Extensive knowledge of Provider contracting, Network operations, Credentialing and recredentialing, Provider enrollment, Provider directory management, Claims operations, Network configuration, Regulatory compliance requirements. Strong analytical, operational, and problem-solving capabilities. Proven ability to lead large-scale operational transformation and process improvement initiatives.

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.

Pay Range: $149,882.00 - $224,823.00

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.