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.
This leader partners closely with Network Management, Provider Contracting, Provider Operations, Technology, Compliance, Product, Claims, Configuration, and Vendor Management teams to ensure the provider data ecosystem supports organizational growth, regulatory compliance, provider satisfaction, and member experience.
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…