Own product requirements for Medicare FFS enrollment workflows within HealthRules Payer, including enrollment transaction processing and plan benefit package configuration.
Drive accumulator configuration requirements for deductible, out-of-pocket maximum and benefit limit tracking across claim types and benefit periods.
Evaluate CMS rulemaking cycles and annual benefit design updates to assess downstream impact on HealthRules Payer configuration and adjudication behavior.
Develop product requirements supporting CMS Medicare FFS provider data standards including NPI validation, taxonomy classification and provider file maintenance aligned to HIPAA requirements.
Ensure provider configuration capabilities align with CMS enrollment, credentialing and revalidation mandates including PECOS data alignment and provider directory accuracy obligations.
Translate CMS provider data regulatory updates into structured product requirements and backlog items while partnering with implementation teams to identify and remediate compliance gaps.
HealthEdge provides an integrated platform of solutions that enables health plans to converge their data and harness insights to improve outcomes. The company has a team of visionary, empathetic people who believe technology should remove friction from healthcare and operate with agility as the regulatory landscape evolves.
Own the product lifecycle end-to-end: discovery, requirements, roadmap planning, feature definition, release execution, and post-launch maintenance for a pre-defined product area.
Lead product initiatives focused on healthcare enrollment, including ingestion, validation, transformation, error handling, reconciliation, and downstream system integrations.
Translate business and regulatory needs into clear product requirements, user stories, acceptance criteria, and product specifications.
Cotiviti is an equal employment opportunity employer and recruits, hires, and promotes individuals based on their qualifications. They ensure all employment decisions are administered in accordance with equal employment opportunity principles.
Oversee enrollment and billing operations across all Government Programs including Medicare Advantage, Medicare Supplement, CHIP, and ACA products to ensure accuracy and operational performance.
Lead Medicare Advantage appeals and grievances operations to ensure timely, compliant resolution and audit readiness in accordance with CMS requirements.
Drive process improvement initiatives and cross-functional coordination to enhance regulatory outcomes, member experience, and operational efficiency.
Capital Blue Cross is a health insurance company and independent licensee of the Blue Cross Blue Shield Association that promises to go the extra mile for its team and community. It is consistently voted one of the 'Best Places to Work in PA,' fosters a flexible environment prioritizing health and wellbeing, and invests heavily in employee training and continuing education.
Drive the creation of payer-specific marketing materials.
Serve as the primary owner for a portfolio of payer products and specialized payer projects.
Report on product and campaign performance and provide recommendations for product enhancement.
Aledade empowers independent primary care practices to deliver better care to their patients and thrive in value-based care. They are the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Enrolls providers new to Privia with all commercial health plans specific to the market.
Updates and maintains provider enrollment status in credentialing system, CredentialStream.
Performs follow up with health plans according to designated timeline, until Provider is PAR.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices. Privia Health consists of scalable cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.
Define and evolve the product vision for how members discover, understand, and use their benefits.
Own the end-to-end product roadmap for member-facing benefits and enrollment features including Member-facing and administrative components.
Establish a single source of truth for benefit content and configuration, mapping legacy data and behaviors into a unified model with engineering and fellow PMs.
Transcarent is the One Place for Health and Careᵀᴹ, bringing medical, pharmacy, and point solutions together. More than 1,700 employers and health plans rely on us to provide information, guidance, and care, empowering health consumers with more choice.
Manage complex provider roster creation, submission, and record reconciliation for multiple payers.
Oversee resolution of moderate-scope issues by prioritizing tasks and escalating issues with solutions.
Proactively identify areas for operational improvement and efficiency enhancement.
Aledade empowers independent primary care practices to deliver better patient care and thrive in value-based care. Founded in 2014, they are the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Own problem discovery, solution design, and delivery for prescriber onboarding & core experience.
Ensure a high standard of care by optimizing the therapist and client experience, focusing on quality & client outcomes.
Initiate, evaluate, and prioritize ideas, gather requirements, and create specifications for all product changes.
BetterHelp's mission is to remove the traditional barriers to therapy and make mental health care more accessible. They are the world’s largest online therapy service with over 30,000 licensed therapists helping millions globally, and they deeply invest in their team’s well-being and professional development.
Conduct in-depth analysis for orders and tasks management and associated service documentation solutions.
Stay abreast of changing customer needs and industry trends.
Prioritize product investments and trade-offs using data-driven analysis and good judgement to create a compelling business case.
PointClickCare helps providers deliver exceptional care. As a leading health tech company, PointClickCare empowers employees to push boundaries, innovate, and shape the future of healthcare. They serve over 30,000 provider organizations.
Oversee prior authorization technicians and administrative PA functions.
Analyze data and provide staffing, workflow, and system enhancement recommendations.
Investigate/resolve escalated issues from clients and providers.
Judi Health is an enterprise health technology company providing a suite of solutions for employers and health plans. They have a comprehensive Enterprise Health Platform that consolidates all claim administration-related workflows in one scalable, secure platform.