Product Manager, Medicare Provider Data Management

🕒 6 days ago

🇺🇸 United States – Remote

💵 $132k - $141k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

✅ Product Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

HealthEdge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2005

⚕️ Healthcare Insurance

☁️ SaaS

💳 Fintech

Healthcare Insurance • SaaS • Fintech

HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.

📋 Description

• Develop HealthRules Payer product requirements supporting CMS Medicare FFS provider data standards, including NPI validation, taxonomy classification, specialty mapping and provider file maintenance aligned to HIPAA standard transaction requirements. • Ensure HealthRules Payer provider configuration capabilities align with CMS enrollment, credentialing and revalidation mandates – including requirements for PECOS data alignment and provider directory accuracy obligations. • Define requirements for provider data ingestion and maintenance workflows within HealthRules Payer, including automated validation rules, exception handling and provider data reconciliation processes. • Translate CMS provider data regulatory updates – including PECOS revalidation cycles, taxonomy code set changes and NPI Registry alignment requirements – into structured product requirements and backlog items. • Partner with implementation and client success teams to identify gaps between HealthRules Payer provider data configuration and client-specific CMS compliance obligations, driving remediation through the product backlog. • Define requirements for provider specialty, practice location and affiliation data management within HealthRules Payer to support accurate claims routing, pricing and directory compliance. • Serve as the embedded Medicare provider data SME, collaborating with engineering and QA to triage, prioritize and track provider data-related backlog items through resolution.

🎯 Requirements

• 5+ years of product management or equivalent experience in healthcare payer operations, provider data management or health plan network operations. • Deep working knowledge of CMS Medicare FFS provider enrollment standards, NPI Registry requirements and PECOS enrollment and revalidation processes. • Strong understanding of HIPAA provider data standards including taxonomy codes, specialty classification and provider file transaction requirements (837/835 provider data elements). • Experience translating CMS regulatory requirements into structured product requirements, user stories and acceptance criteria in an Agile development environment. • Familiarity with provider directory accuracy obligations, CMS network adequacy standards and provider credentialing workflows. • Exceptional collaboration and communication skills with the ability to align engineering, implementation and client stakeholders around a shared provider data roadmap.

🏖️ Benefits

• Health insurance • 401(k) matching • Flexible work hours • Paid time off • Remote work options