Product Manager, Medicare Provider Data Management
New
United States, cross-time-zone collaborationFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 5+ years
- Required Skills
- AgileProduct ManagementHIPAA
Requirements
- 5+ years of product management or equivalent experience in healthcare payer operations, provider data management, or network/credentialing environments.
- Deep knowledge of CMS Medicare Fee-for-Service provider standards, including PECOS enrollment, NPI registry processes, and revalidation requirements.
- Strong understanding of HIPAA provider data standards, taxonomy codes, and provider file transaction structures used in healthcare claims systems.
- Experience translating regulatory and compliance requirements into product specifications, user stories, and Agile development workflows.
- Familiarity with provider directory accuracy requirements, network adequacy standards, and credentialing lifecycle processes.
- Strong collaboration and communication skills, with the ability to align technical and non-technical stakeholders around complex data requirements.
- Experience with healthcare provider data governance, master data management (MDM), or related frameworks.
Responsibilities
- Define and manage product requirements for provider data standards including NPI validation, taxonomy classification, specialty mapping, and provider file maintenance aligned with CMS guidelines.
- Translate CMS regulatory updates (PECOS, enrollment, revalidation cycles, taxonomy changes) into structured product requirements, user stories, and backlog priorities.
- Ensure provider data workflows support accurate enrollment, credentialing, directory accuracy, and claims processing within Medicare Fee-for-Service environments.
- Design and refine provider data ingestion, validation, reconciliation, and exception-handling processes within the platform.
- Partner with implementation and client success teams to identify compliance gaps and drive remediation through product enhancements.
- Serve as the subject matter expert for provider data governance, collaborating with engineering and QA to ensure accurate delivery and issue resolution.
- Support alignment of provider data structures with downstream operational needs including pricing, claims routing, and network adequacy reporting.
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