Manager, Clinical Data Management

Primary Duties Data Submission & Reconciliation Process

- Oversee end-to-end strategy, priorities, and operations for accurate and compliant encounter data submission to payers and CMS.

- Create and transmit ASM files on established cadences, maintaining payer-specific templates and submission methods annually.

- Establish routine reconciliation processes to track diagnoses from documentation to acceptance, quantifying gaps and identifying dropped/truncated records early.

- Lead root-cause analysis and corrective action across internal teams, vendors, and payers for rejected or dropped diagnoses.

- Partner with operations leadership to drive strategy, chart selection, and annual evaluation for the retrospective chart review initiative.

Compliance & Quality Assurance

- Monitor submission metrics and acceptance rates, applying data scrubs and business rules to meet regulatory standards and CMS/payer deadlines.

- Collaborate with leadership and legal partners to ensure full compliance regarding add and delete diagnosis workflows.

- Develop and maintain process documentation, SOPs, and routine workflow updates.

Process Improvement

- Identify tools and long-term strategies to improve encounter acceptance rates, minimize manual effort, and expand ASM processes across eligible payers.

- Evaluate annual ROI across submission and audit processes, optimizing workflows to drive financial performance.

Cross-Functional Collaboration

- Lead cross-functional initiatives with key stakeholders to resolve data flow issues and implement system updates.

- Integrate accepted ASM submitted diagnosis data into existing risk reporting dashboards and build new recurring reports for leadership

- Own ASM valuation and financial results, partnering with Data and Analytics on metric definitions and data quality

Other duties as assigned

Minimum Qualifications - Bachelor’s degree in Business, Finance, IT, Healthcare Analytics, or Operations

- 6+ years of experience with Medicare Advantage or ACA encounter data processes, and/or risk adjustment experience within a payer, vendor, or Value Based Care organization

- 3+ years of program or project management experience, including ownership of complex, multi-stakeholder initiatives

- 2+ years of working knowledge with X12 837 transaction sets; Working knowledge of CMS EDPS experience (MAO-002/MAO-004 reports)

- Strong analytical capabilities with a demonstrated ability to interpret complex datasets and synthesize actionable insights

- Excellent written and verbal communication skills, with proven experience developing and presenting key information to executive leadership

- Working knowledge of SQL, including writing, modifying, and executing queries

- Proficiency in Google Workspace, project tracking software (i.e. Jira, Smartsheet), and business intelligence or dashboard platforms

Preferred Qualifications - Familiarity with Business Process Reengineering (BPR) principles and methodologies to optimize processes for enhanced efficiency and performance

- Experience with chart selection or targeting strategies for retrospective chart review

- Fundamental understanding of relational databases

Physical Requirements - Prolonged periods of sitting at a desk and working on a computer

Who We Are: Aledade PBC, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of health plans, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to