Product Manager, Payment Integrity

Employment Type: Full Time

Company Overview

Hi, we’re Gravie. Our mission is to improve the way people purchase and access healthcare through innovative, consumer-centric health benefit solutions that people can actually use. Our industry-changing products and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way.

Role Overview

We’re looking for a Product Manager, Payment Integrity to create and deliver a roadmap of investments in payment integrity capabilities such as code editing, bill review, fraud / waste / abuse detection, subrogation, and coordination of benefits to ensure Gravie pays all medical claims correctly. You will be responsible for creating and prioritizing a Payment Integrity roadmap; defining requirements; identifying and evaluating potential vendors for prioritized capabilities; creating user stories for internally developed capabilities and components; partnering with operations, product, and project management; and maintaining a dashboard of Payment Integrity performance.

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.

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.

Extra Credit

• 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.