Remote Product Owner: Claims Editing & Revenue Enablement

Vaco; Tampa (FL); Remote; USD 120,000 - 135,000; Full time

Benefits offered by this job

Remote in US

Job summary

Vaco is seeking a Product Owner, Claims Editing, to identify, design, and support automated claim edits that improve payment accuracy and revenue across claims-editing programs. Initial focus on Routine Test Management (RTM) with potential for RTM-like work in Radiology and Genetic Testing management.

The role partners with Scientific Affairs and Coding & Translation to review policies, translate requirements into clear rules, and analyze claims data using AI tools to estimate impact.

Qualifications

• 4+ years of experience in healthcare claims editing, payment integrity, medical coding, reimbursement, medical policy, or claims analytics.
• Working knowledge of healthcare claims, claims adjudication, medical coding systems, and automated claim-editing concepts.

Responsibilities

• Maintain a prioritized pipeline of opportunities to enhance existing policies and develop new automated claim edits.
• Review medical policies, coding guidance, regulatory updates, and new publications to identify opportunities for enforcement.
• Translate approved policy requirements into clear, testable business rules and configuration specifications.
• Evaluate existing claim-editing capabilities and recommend new functionality when needed.
• Analyze claims data using approved AI/LLM tools to estimate eligible claim volume, potential savings, incremental revenue, and client impact.
• Develop claim examples and test scenarios, coordinate handoffs to Configuration, and validate claim-editing decisions and outcomes.
• Create training materials, process walkthroughs, FAQs, and decisioning examples for Product, Account Management, and clients.
• Monitor implemented edits and recommend enhancements to improve accuracy, financial performance, and client adoption.
• Serve as a liaison among multiple teams to ensure alignment throughout the edit lifecycle.

Skills

Claims editing

Policy knowledge

Data analysis

Education

Bachelor's degree or 8+ years experience

Tools

SQL

Excel

BI tools

Job description

Vaco is seeking a Product Owner, Claims Editing, to identify, design, and support automated claim edits that improve payment accuracy and revenue across claims-editing programs. Initial focus on Routine Test Management (RTM) with potential for RTM-like work in Radiology and Genetic Testing management.

The role partners with Scientific Affairs and Coding & Translation to review policies, translate requirements into clear rules, and analyze claims data using AI tools to estimate impact.