[Hiring] Product Manager, Medicare Provider Data Management @HealthEdge

Role Description

HealthEdge is seeking a Product Manager with deep expertise in CMS Medicare Fee-for-Service provider data standards to join the HealthRules® Payer product team. In this role, you will own the product requirements that define how health plans onboard, validate, maintain and operationalize provider data within the HealthRules Payer platform – ensuring alignment with CMS enrollment, credentialing and revalidation mandates.

You will partner cross-functionally with engineering, QA, implementation and client success to ensure HealthRules Payer provider data capabilities are accurate, compliant and scalable – empowering our health plan clients to meet provider directory accuracy obligations and support clean claims adjudication.

What You Will Own

• The product requirements governing provider data standards, NPI validation, taxonomy classification, PECOS alignment and provider directory accuracy obligations within HealthRules® Payer – ensuring health plan clients meet CMS provider data integrity mandates.

What you'll do

• 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.

Qualifications

• 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.

Preferred Qualifications

• Direct experience with HealthRules Payer or similar core administrative processing (CAPS) platforms.
• Knowledge of CAQH ProView, PECOS and provider data exchange standards.
• Background in health plan provider relations, network management or credentialing operations in a SaaS payer technology environment.
• Experience with provider data governance frameworks and master data management (MDM) concepts in healthcare payer contexts.

Benefits

• Remote, US
• Full-time, permanent
• Exempt (FLSA Classification)

Work Environment

• The employee is occasionally required to move around the office.
• Specific vision abilities required include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
• Work across multiple time zones in a hybrid or remote work environment.
• Long periods of time sitting and/or standing in front of a computer using video technology.
• May require travel dependent on company needs.

Compensation

The annual US base salary range for this position is $132,000 to $141,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.