Product Manager, Medicare Enrollment – Benefits

🕒 il y a 10 jours

🇺🇸 États-Unis – Télétravail

💵 $132 000 - $141 000 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

✅ Responsable Produit

🦅 Parrain de Visa H1B

Cette entreprise a parrainé des visas H1B par le passé.

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HealthEdge

Site WebLinkedInTous les Emplois

1001 - 5000 employés

Fondée en 2005

⚕️ Assurance santé

☁️ SaaS

💳 Fintech

Healthcare Insurance • SaaS • Fintech

HealthEdge est une entreprise spécialisée dans la fourniture de solutions avancées pour les gestionnaires de soins de santé grâce à sa suite HealthRules Solutions. Cette suite comprend un système complet de traitement administratif des réclamations numériques, des solutions de gestion des workflows de soins et des solutions d'intégrité des paiements, visant à améliorer l'efficacité opérationnelle et la qualité des soins pour les régimes de santé. En tirant parti de la technologie intégrée et de l'automatisation, HealthEdge aide les régimes de santé à éliminer les silos de données, à accroître la précision des paiements et à améliorer l'expérience des membres, transformant ainsi le paysage des soins de santé pour une meilleure collaboration et accessibilité.

Description

• Own product requirements for Medicare FFS enrollment workflows within HealthRules Payer, including enrollment transaction processing, plan benefit package configuration and enrollment reconciliation against CMS enrollment data. • Define system behavior requirements for benefit design parameters including cost-sharing structures, benefit period logic, coverage exceptions and benefit limit enforcement as configured in HealthRules Payer. • Drive accumulator configuration requirements for deductible, out-of-pocket maximum and benefit limit tracking across claim types, benefit periods and coordination of benefits scenarios within the HealthRules Payer accumulator framework. • Evaluate CMS rulemaking cycles and annual benefit design updates to assess downstream impact on HealthRules Payer configuration and adjudication behavior, translating mandates into structured product requirements and acceptance criteria. • Maintain a benefit design and enrollment change calendar aligned to CMS implementation timelines, sequencing HealthRules Payer releases to support client change readiness. • Partner with implementation and client success teams to validate HealthRules Payer benefit configuration output against CMS enrollment records and member cost-sharing expectations, driving gap resolution through the product backlog. • Serve as the embedded Medicare enrollment and benefit design SME, triaging and prioritizing regulatory-driven backlog items in collaboration with engineering and QA through resolution.

🎯 Exigences

• 5+ years of product management or equivalent experience in healthcare payer operations, Medicare FFS benefit administration or health plan enrollment processing. • Deep working knowledge of Medicare FFS plan benefit package structure, CMS enrollment transaction requirements and annual benefit design update cycles. • Experience translating CMS regulatory requirements into structured product requirements, user stories and acceptance criteria in an Agile development environment. • Strong understanding of accumulator mechanics – deductible, out-of-pocket maximum and benefit limit tracking across multiple claim types and benefit periods. • Familiarity with coordination of benefits (COB) rules and their interaction with Medicare FFS benefit design configurations. • Exceptional collaboration and communication skills with the ability to align engineering, implementation and client stakeholders around a shared benefit design roadmap.

🏖️ Avantages

• Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development opportunities