Product Manager, Payment Integrity

Summary

Join Gravie as a Product Manager, Payment Integrity and build a roadmap for payment integrity capabilities, including claim editing, bill review, fraud detection, and subrogation. You will define requirements, evaluate vendors, create user stories, and partner with various teams. The role involves defining operational and financial goals, monitoring performance, and staying updated on industry standards. You will collaborate with operations, finance, and legal teams to develop solutions. This position requires 5+ years of healthcare product management experience and a bachelor's degree. Gravie offers a competitive salary and benefits package including flexible PTO, parental leave, 401k, and more.

Requirements

• 5+ years of experience in health care product management, consulting, or other similar role collaborating with product managers, operators, financial leaders, engineers, and other functions
• 2+ years of experience managing structured prioritization processes
• Experience with healthcare data, including claims, EDI transactions, and coding standards
• Experience with health plan and provider network concepts
• Bachelors degree

Responsibilities

• Maintain a roadmap of investments in internally developed capabilities and vendor solutions in key areas that impact the accurate payment of medical claims, such as claim / code editing, hospital bill review, DRG validation, fraud / waste / abuse detection, subrogation, and coordination of benefits
• Create systems that maximize the identification and adjustment of incorrect claims prior to payment without exceeding timely payment and other operational performance requirements
• Define operational and financial goals in each payment integrity domain, aggregate data to evaluate performance against these goals, and regularly publish and verbally communicate performance updates
• Regularly review the performance of each vendor and internally developed capability relative to internal and external benchmarks; iterate decisively when performance deficits or upside opportunities are identified
• Keep current on industry innovations, standards and regulations to ensure all payment integrity solutions are strictly compliant with applicable regulations and consistent with industry best practices
• Collaborate with operations, finance, and legal to develop implementable solutions
• Perform other duties as assigned

Preferred Qualifications

• Experience with payment integrity, revenue cycle management, or health plan / payer operations and claims processing
• Proficiency with tools such as Jira and other backlog or project tracking platforms
• Experience managing third-party vendor relationships
• Comfort working with both highly technical users (e.g., engineers) and non-technical stakeholders (e.g., Finance, Operations)
• Strong project management skills including timeline management and prioritization using Agile methodologies (e.g., Scrum)
• Understanding of the complete Software Development Lifecycle (SDLC), especially in ambiguous or shifting problem spaces
• Self-starter mindset with the ability to independently achieve defined goals
• Proven ability to motivate and influence cross-functional teams without direct authority

Benefits

• Health insurance
• Alternative medicine coverage
• Flexible PTO
• Up to 16 weeks paid parental leave
• Paid holidays
• A 401k program
• Cell phone reimbursement
• Transportation perks
• Education reimbursement
• 1 week of paid paw-ternity leave