Director, ACO Operations
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Job Description
Director of ACO Operations at Pearl Health overseeing CMS Program Operations and ensuring compliance. Managing provider submissions, strategic oversight, and operational tasks for healthcare programs.
Responsibilities:
- Lead the end-to-end Provider Submission process
- Manage the Roster Management System (RMS) workflow
- Provide strategic oversight and execution of Beneficiary Enhancement (BE) and Beneficiary Engagement Incentive (BEI) programs
- Direct the development of educational materials and training programs
- Oversee mandatory CMS operational tasks
- Responsible for CMS-related knowledge management
- Manage external resources and contractors during high-volume periods
Requirements:
- Orchestrate complex, multi-phase project lifecycles
- Maintain a zero-margin-for-error standard while overseeing the ingestion and processing of high-volume, mission-critical data sets
- Proactively identify and resolve bottlenecks in data-intensive workflows
- Deep technical knowledge of value-based care programs (eg. ACO REACH and/or MSSP) and regulations
- Accountability for regulatory deadlines, with a proven track record of meeting multi-stakeholder filing requirements without constant oversight.
- Direct experience with CMS provider submissions, having successfully managed at least one full roster cycle for an ACO or similar value-based care entity.
- Experience implementing or managing a Roster Management System (RMS) or similar tool used to automate provider data flows.
- Background in CMS program management or policy, particularly experience with BEI programs and compliance frameworks.
- Prior leadership in a high-growth startup environment.
Benefits:
- Competitive benefits package. More on our careers page.
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