Director, ACO Operations

Pearl Health, Inc.

Job Overview

Location

Seattle, New York City, Boston, or Remote

Job Type

Full-time

Full Job Description

📋 Description

• As the Director of ACO Operations at Pearl Health, you will serve as the operational backbone of the organization’s value-based care mission, ensuring the integrity and scalability of CMS-compliant ACO programs that directly impact thousands of Medicare beneficiaries across 44 states. This role is mission-critical: you will transform a high-pressure, reactive submission process into a resilient, automated, and scalable engine that enables Pearl Health to grow without compromising compliance or quality.
• You will lead the end-to-end Provider Submission process, owning roster accuracy and CMS deadline adherence during critical submission windows, acting as the accountable leader who ensures zero errors in high-stakes regulatory filings that determine network eligibility and financial sustainability.
• You will manage and modernize the Roster Management System (RMS) workflow, overseeing the transition from manual, error-prone data handling to a streamlined, automated submission pipeline that reduces cycle time and increases data fidelity under intense regulatory scrutiny.
• You will provide strategic oversight and execution of Beneficiary Enhancement (BE) and Beneficiary Engagement Incentive (BEI) programs, ensuring all filings are precise, timely, and fully aligned with evolving CMS standards to unlock enhanced benefits for members and financial incentives for providers.
• You will direct the development of educational materials and training programs for internal teams, translating complex CMS regulations into accessible knowledge that empowers Pearl employees across Product, Client Success, and Quality to operate with regulatory fluency.
• You will oversee mandatory CMS operational tasks including CEHRT compliance, MSSP applications, and beneficiary notification coordination, ensuring every touchpoint meets federal standards while maintaining audit readiness and documentation excellence.
• You will manage external contractors and vendors during peak submission cycles, enforcing rigorous quality-control standards under tight timelines to prevent costly delays or compliance risks.
• You will partner with Program Owners and Subject Matter Experts to modernize knowledge management, documenting processes and best practices to eliminate tribal knowledge and create a repeatable, scalable operational framework that outlives any individual contributor.
• You will operate as a player-coach leader — equally comfortable diving into tactical data validation during sprint periods and advising senior leadership on strategic program evolution — ensuring Pearl Health’s ACO operations remain agile, compliant, and ahead of regulatory curves.
• You will join a mission-driven, innovative team backed by top-tier investors (Andreessen Horowitz, Viking Global, AlleyCorp) that values transparency, collaboration, and impact — where your work directly enables primary care providers to deliver better, more proactive care to Medicare patients while lowering system-wide costs.
• In this role, you will develop deep expertise in CMS value-based care programs (ACO REACH, MSSP, BEI), become a trusted authority on regulatory operations within Pearl Health, and build a legacy operational framework that scales with the company’s growth — positioning you as a leader in the evolving landscape of value-based care operations.

🎯 Requirements

• Orchestrate complex, multi-phase project lifecycles with zero tolerance for error, ensuring seamless delivery of high-volume, mission-critical CMS submissions under rigid deadlines and intense pressure.
• Possess deep technical knowledge of value-based care programs (ACO REACH and/or MSSP) and CMS regulations, with proven ability to translate complex guidelines into actionable, compliant project plans.
• Demonstrate a track record of maintaining zero-margin-for-error standards while overseeing ingestion, processing, and validation of high-stakes provider and beneficiary data sets.
• Have experience managing external resources and contractors during high-volume periods to uphold quality control without sacrificing speed or compliance.
• (Nice-to-have) Direct experience managing at least one full CMS provider submission roster cycle for an ACO or similar value-based care entity.
• (Nice-to-have) Background in implementing or managing a Roster Management System (RMS) or similar tool to automate provider data flows and reduce manual effort.

🏖️ Benefits

• Competitive base salary range of $150,000 - $195,000 per year, reflective of the role’s strategic importance and operational complexity.
• Eligibility for discretionary performance bonuses and equity options, aligning your compensation with Pearl Health’s long-term growth and mission success.
• Access to a competitive benefits package (details available on Pearl Health’s careers page), supporting your health, well-being, and work-life flexibility across remote or hybrid locations in Seattle, NYC, Boston, or fully remote.

Skills & Technologies

Remote

$150k-195k

Degree Required

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Pearl Health, Inc.

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About Pearl Health, Inc.

Pearl Health is a technology company that provides data-driven tools to primary care physicians for managing value-based care contracts. Its platform aggregates and analyzes claims, clinical, and social data to identify high-risk patients, surface actionable insights, and track performance against quality and cost metrics. By offering workflows, benchmarking, and financial reconciliation, the company helps independent practices shift from fee-for-service to risk-sharing arrangements with Medicare Advantage and other payers, aiming to improve patient outcomes while increasing physician revenue.

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