Director | New Product R&D

10+ years in healthcare with 7+ years focused on Payment Integrity, claims analytics, medical coding/audit, or payer operations. 4–6+ years leading cross-functional domain initiatives or teams. 3+ years partnering directly with Data Science and Engineering on data-driven products; health tech experience required. Strong, hands-on experience with a Payment Integrity platform (e.g., Machinify or comparable). Deep understanding of claims data and adjudication flows, including X12/EDI, CARC/RARC, billing guidelines, and payer policy. Strong grasp of coding and regulatory standards: ICD-10-CM/PCS, CPT/HCPCS, DRG/APC, NCCI, CMS NCD/LCD, IPPS/OPPS. Knowledge of compliance, privacy, and auditability requirements. Expert at validating user stories, acceptance criteria, decision tables, and comprehensive test plans. Proficient with Jira. Data fluency: able to interpret analytics dashboards, partner on experiments, and evaluate model/rule performance. Executive presence with excellent facilitation and written communication skills. Proven track record influencing PM-led prioritization and aligning Engineering and DS around domain-driven requirements. Bachelor’s degree in health administration, informatics, nursing/clinical discipline, public health, or related field required.

Lead domain strategy within Product, defining vision and standards for Payment Integrity. Establish governance for policy/clinical accuracy, model validation, and compliance. Develop expertise in Machinify’s platform capabilities for concept ideation and solution design. Partner hands-on with Data Science to define labeling guidance, sampling strategies, and evaluation metrics. Review and critique features and model outputs, recommending adjustments. Maintain curated test sets reflecting NCCI edits, DRG/APC logic, CMS NCD/LCD, and payer rules. Serve as the market and regulatory intelligence engine, monitoring updates and trends. Deliver POVs and impact briefs, translating shifts into product opportunities and risks. Aggregate and structure inputs from SME Operations, client services, and customers into actionable requirements. Support cross-functional execution and enablement through requirement reviews, design critiques, and UAT oversight. Conduct trainings and workshops to upskill teams on domain concepts. Define domain-level OKRs and success metrics to drive continuous improvement. Provide executive-level communication, influence, and stakeholder management.