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VP, VBC Operations

Who we are…

Pearl Health is powering the future of healthcare. We help primary care providers and organizations to deliver quality healthcare to the patients who need it most, when they need it most — and get rewarded for keeping patients healthy.

Our technology, services, and financial tools enable better, more proactive care, decrease total cost of care across patient panels, and optimize performance in value-based care models for Traditional Medicare and Medicare Advantage.

We are a team of physicians and public health experts (Stanford, Harvard, Mount Sinai), technologists (athenahealth, Amazon, Meta, Flatiron), healthcare innovators (Centivo, Aledade, Stellar, Arcadia), and experienced risk management professionals (CVS/Aetna, Humana, Oscar) who believe that primary care providers are the key to addressing our healthcare system’s biggest challenges.

Since its founding in 2020, Pearl has expanded to partner with thousands of primary care providers in practices and organizations across 44 states. Our investors include Andreessen Horowitz, Viking Global Investors, AlleyCorp, and SV Angel.

The role…

The VP, VBC Operations will lead Pearl Health's efforts to ensure Medicare patients managed by our practice partners have appropriate benchmarks based on their condition. This critical role focuses on creating systems, developing vendor and internal capabilities, and strengthening client partnerships. The ideal candidate will enable the generation of savings against fair benchmarks while maintaining clinical integrity and regulatory compliance.

The role will report directly to the Chief Operating & Compliance Officer.

Key Responsibilities

  • Improve upon and excellently execute a comprehensive benchmark accuracy strategy for Traditional Medicare

  • Create scalable, compliant processes that can adapt to changing regulations and practice needs

  • Build programs that equip providers with actionable insights to improve diagnosis accuracy

  • Partner with Pearl’s Customer Success team to drive provider engagement in benchmark accuracy initiatives through education and support

  • Translate complex risk adjustment concepts into actionable guidance for clinical teams

  • Partner with R&D, Finance, Actuarial, Data Science & Analytics and Customer Success teams on data-driven strategic prioritization and partner selection

  • Coordinate with external vendors to enhance capabilities and fill strategic gaps

  • Identify and implement technology solutions that aggregate claims, encounter, and clinical data

  • Drive proactive condition identification through advanced analytics

  • Ensure all activities adhere to CMS guidelines and documentation requirements

  • Stay ahead of policy changes and adapt strategies accordingly

Qualifications

Experience

  • 7+ years of experience in healthcare operations, with significant focus on value-based care or risk adjustment initiatives a plus

  • Proven track record of developing and scaling benchmark accuracy or risk adjustment programs

  • Experience engaging with providers and health system leaders on clinical documentation improvement

  • Deep understanding of regulatory and compliance requirements relevant to the above domains

  • Demonstrable success in Traditional Medicare value-based models (MSSP, GPDC, ACO REACH, etc.); comparable experience in Medicare Advantage programs a plus

Skills & Attributes

  • Exceptional operational leadership with attention to detail and process excellence

  • Strong understanding of CMS risk adjustment methodologies and regulatory requirements, or demonstrated experience with comparable subject matter and ability to ramp rapidly

  • Ability to translate complex data into actionable insights for clinical teams

  • Outstanding communication skills at all levels of an organization

  • Data-driven decision making with a focus on measurable outcomes

  • Strategic thinking balanced with a bias towards execution

  • Strong organizational skills and detail-orientation. 

  • Capability of effectively handling multiple priorities in a fast-paced environment as part of a lean team.

Background

  • Bachelor's degree or equivalent required; Master's degree in healthcare administration, business, public health, or related field preferred

  • Clinical background or certification in risk adjustment, coding, or healthcare compliance is a nice-to-have

Our Values

We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people's lives. Our definition of diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. We believe all of our colleagues’ points of view are integral to our success, and that inclusion is everyone's responsibility and a cause of beautiful things.

We welcome candidates from all backgrounds and are committed to a fair hiring process free from discrimination and focused around problem solving, improvement, and mutual empowerment.

Agency Submissions

If a resume is submitted to any Pearl Health employee by a third party without a valid written and signed search agreement, it will become the property of Pearl Health and no fee will be paid, irrespective of whether the candidate is hired.

Compensation and Benefits

The salary range Pearl Health expects to pay for this position is between $175,000 and $225,000 per year.  Full time employees are also eligible for annual discretionary bonus and equity options. Where a given candidate falls within the compensation  range will depend on a variety of factors, including, but not limited to, the candidate’s relevant skills, experience and location, labor market conditions and participation, if any, in other compensation arrangements. 

Remote candidates will be considered. Candidates based in the New York City area may be given preference.

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Average salary estimate

$200000 / YEARLY (est.)
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$175000K
$225000K

If an employer mentions a salary or salary range on their job, we display it as an "Employer Estimate". If a job has no salary data, Rise displays an estimate if available.

What You Should Know About VP, VBC Operations, Pearl Health

Are you ready to take your healthcare operations leadership to the next level? Pearl Health is on the lookout for a dynamic VP, VBC Operations to join our team in New York City. At Pearl Health, we're dedicated to revolutionizing healthcare for Medicare patients by ensuring our primary care providers deliver top-notch services when it's needed most. As the VP, VBC Operations, you'll play a pivotal role in developing comprehensive strategies for benchmark accuracy in Traditional Medicare, enhancing clinical integrity while adhering to regulatory compliance. Your expertise will guide us in creating scalable processes that respond proactively to changing regulations and evolving practice needs, all aimed at improving patient outcomes. You'll collaborate with multiple teams, translating complex risk adjustment concepts into actionable insights that empower providers. Plus, with your skills in strategic prioritization and data-driven decision-making, you’ll help identify technology solutions that aggregate essential data. If you have over 7 years of healthcare operations experience, particularly in risk adjustment initiatives, and possess exceptional communication and organizational skills, we want to hear from you. Join us in our mission to empower primary care providers and reshape the future of healthcare!

Frequently Asked Questions (FAQs) for VP, VBC Operations Role at Pearl Health
What are the key responsibilities of the VP, VBC Operations at Pearl Health?

The VP, VBC Operations at Pearl Health will oversee the development and execution of benchmark accuracy strategies for Traditional Medicare. This includes creating scalable processes for compliance, building programs to improve diagnosis accuracy, and partnering with various teams to drive strategic prioritization and improve data analytics.

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What qualifications are required for the VP, VBC Operations position at Pearl Health?

Candidates for the VP, VBC Operations position at Pearl Health should have at least 7 years of experience in healthcare operations, especially in value-based care or risk adjustment initiatives. A Bachelor's degree is required, with a Master's degree in healthcare administration or a related field preferred. Experience with Medicare models and regulatory compliance is essential.

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How does the VP, VBC Operations role impact patient care at Pearl Health?

The VP, VBC Operations plays a crucial role in enhancing patient care by ensuring that benchmark accuracy is achieved for Medicare patients. By developing systems and processes that maintain clinical integrity and compliance, this position directly contributes to delivering high-quality healthcare services to patients.

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What skills are essential for success as the VP, VBC Operations at Pearl Health?

Essential skills for the VP, VBC Operations include exceptional operational leadership, understanding of CMS risk adjustment methodologies, effective communication, strategic thinking, and the ability to handle multiple priorities. The role also requires a strong focus on data-driven decision-making.

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Can remote candidates apply for the VP, VBC Operations role at Pearl Health?

Yes, Pearl Health is open to considering remote candidates for the VP, VBC Operations position. However, those based in the New York City area may be given preference during the selection process.

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Common Interview Questions for VP, VBC Operations
What strategies would you implement to improve benchmark accuracy in a value-based care model?

To improve benchmark accuracy, I would assess current practices, identify gaps in data collection, and ensure compliance with CMS guidelines. Implementing training programs for clinical staff and leveraging advanced analytics would also be key tactics.

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Can you explain your experience with regulatory compliance in healthcare operations?

In my previous roles, I ensured compliance by regularly reviewing policies against CMS regulations, conducting training sessions, and implementing internal audits to minimize risk while promoting best practices in clinical documentation.

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How do you prioritize multiple projects in a fast-paced healthcare environment?

I prioritize projects by assessing their impact on patient outcomes and aligning them with strategic organizational goals. Utilizing project management tools and maintaining open communication within my team also helps manage timelines effectively.

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Describe a situation where you transformed complex data into actionable insights.

At my last position, I led a project analyzing patient data to identify care gaps. By translating the findings into understandable reports and working sessions with clinical teams, we successfully improved patient engagement in their care plans.

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How would you approach building partnerships with external vendors?

I would start by assessing our specific needs and aligning those with potential vendors' strengths. Establishing a clear framework for collaboration, regular communication, and bi-directional feedback would be critical for a successful partnership.

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What has been your experience with creating scalable healthcare processes?

I have experience developing scalable processes by conducting pilot programs, analyzing performance metrics, and adjusting implementations based on stakeholder feedback. This ensures processes can adapt as regulations and needs evolve.

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Can you discuss a successful project you've led in a value-based care context?

I led a project improving clinical documentation accuracy that resulted in a 25% increase in reported benchmark performance for a Medicare population, significantly impacting our risk adjustment revenue and ensuring better patient care.

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What techniques would you use to engage providers in benchmark initiatives?

Engaging providers can be achieved through regular educational sessions about the importance of benchmarks, presenting data-driven success stories, and providing hands-on support to address questions or concerns about implementation.

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How do you stay updated on changes in healthcare regulations?

I make it a priority to engage with industry networks, attend relevant conferences, and subscribe to leading healthcare publications. This ongoing education helps ensure my team and I incorporate the latest regulations into our operational strategies.

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What role do you see technology playing in the future of healthcare operations?

Technology is crucial for enhancing efficiency and improving outcomes. Utilizing data analytics, machine learning, and streamlined patient management systems will be integral for future healthcare operations, particularly in value-based care models.

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EMPLOYMENT TYPE
Full-time, hybrid
DATE POSTED
March 9, 2025

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