Product Manager, Medicare Provider Data Management

What You Will Own:

• The product requirements governing provider data standards, NPI validation, taxonomy classification and PECOS alignment within HealthRules Payer platform
• Ensuring health plan clients meet CMS provider data integrity mandates and provider directory accuracy obligations

Provider Data Management Responsibilities:

• Define requirements for provider data ingestion and maintenance workflows including automated validation rules and exception handling
• Partner with implementation and client success teams to identify gaps between platform configuration and client-specific CMS compliance obligations
• Serve as embedded Medicare provider data SME, collaborating with engineering and QA to triage and prioritize backlog items

Required Qualifications:

• 5+ years of product management or equivalent experience in healthcare payer operations or provider data management
• Deep working knowledge of CMS Medicare FFS provider enrollment standards and PECOS enrollment processes
• Strong understanding of HIPAA provider data standards including taxonomy codes and specialty classification
• Experience translating CMS regulatory requirements into structured product requirements in Agile environments