Product Manager Jobs

About The Position

Requirements

• At least 7 years of configuration oversight, claims, auditing, and/or health care operations experience in a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs, or an equivalent combination of relevant education and experience.
• At least 1 year of management/leadership experience.
• Advanced understanding of claims processes.
• Advanced ability to identify and troubleshoot claim discrepancies by utilizing benefit and provider contracts, regulatory requirements, and various claims-related resources.
• Strong analytical, critical-thinking, and problem-solving skills.
• Strong multitasking ability and decision-making skills.
• Flexibility to meet changing business requirements and a strong commitment to high-quality/on-time delivery.
• Ability to work cross-collaboratively in a highly matrixed organization.
• High attention to detail.
• Strong verbal and written communication skills.
• Microsoft Office suite proficiency, including intermediate to advanced Excel abilities (VLOOKUP/Pivot Tables, etc.), and proficiency in applicable software programs.

Nice To Haves

• Certified Professional Coder (CPC).
• Experience leading analysis and operational teams in a managed care setting.
• Experience collaborating with various levels of leadership in a highly matrixed organization.
• Deep claims processing, configuration, and queries experience.

Responsibilities

• Manages the configuration team and is accountable for team performance, including meeting or exceeding established performance targets based on health plan, federal, or state requirements.
• Serves as the primary liaison with various functional areas and stakeholders (e.g., utilization management, claims, configuration, provider network, health plan leadership) to understand workflows and gather documentation for audits.
• Leads and organizes audit submissions and interacts with auditors.
• Develops policies and procedures for the end-to-end audit process to ensure consistency and compliance.
• Supports the review of operational policies, procedures, guidelines, and job aids to ensure compliance with company and government regulations.
• Identifies risks related to operational oversight processes, recommends mitigation solutions, and reports to leadership.
• Participates in and contributes to the development of configuration-related strategies to meet business needs.
• Conducts and documents monthly operational meetings with health plans.
• Provides guidance to the team regarding the interpretation of specific state and/or federal benefits, benefit and provider contracts, and business requirements (e.g., coding, system tables, fee schedules), and converts terms to configuration parameters.
• Develops and coaches the direct configuration team, promoting professional growth and development.
• Maintains awareness of current laws, regulations, and statutes for assigned operational areas audited by the team.
• Proactively works with leadership on operational effectiveness to ensure compliance.
• Performs analysis and reviews to ensure configuration performance targets are met.
• Plans daily priorities and responds to new priorities and opportunities assigned by leadership.
• Assists with compiling and submitting daily, weekly, and monthly departmental reports to leadership.
• Acts as a technical expert in handling complaints and escalated issues from internal customers.
• Leads performance improvement activities for the configuration function.
• Manages fluctuating work volumes and prioritizes work to meet deadlines and the needs of the configuration department and user community.
• Hires, trains, develops, and manages the team, demonstrating accountability for team performance and achievement of configuration/department-specific goals.

Benefits

• Competitive benefits and compensation package