Remote Product Owner, Claims Editing & Revenue Impact

Vaco; Tampa (FL); Remote; USD 120.000 - 135.000; Vollzeit

Zusammenfassung

Vaco is seeking a Product Owner, Claims Editing, to design and support automated claim edits that drive value and improve payment accuracy. The role focuses on Routine Test Management (RTM) with potential expansion to RTM-related areas.

You will partner with Scientific Affairs, Coding & Translation, and Analytics to translate requirements into configuration-ready rules and to estimate financial impact, collaborating with cross-functional teams throughout the lifecycle.

Qualifikationen

• 4+ years of experience in healthcare claims editing, payment integrity, medical coding, reimbursement, medical policy, or claims analytics.
• Bachelor's degree in a related field, or 8+ years of directly applicable experience.
• Working knowledge of healthcare claims, claims adjudication, medical coding systems, and automated claim-editing concepts.
• Experience analyzing claims data and estimating operational and financial impact using Excel, SQL, business intelligence tools, or similar analytical solutions.
• Familiarity with generative AI and large language models (LLMs).
• Strong analytical, documentation, presentation, and cross-functional communication skills.

Aufgaben

• 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 additional 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 and other analytical methods 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 development lifecycle.

Kenntnisse

Analytical skills

Documentation

Presentation skills

Cross-functional collaboration

Generative AI familiarity

Ausbildung

Bachelor's degree

8+ years relevant experience

Tools

Excel

SQL

Business Intelligence tools

Jobbeschreibung

Vaco is seeking a Product Owner, Claims Editing, to design and support automated claim edits that drive value and improve payment accuracy. The role focuses on Routine Test Management (RTM) with potential expansion to RTM-related areas.

You will partner with Scientific Affairs, Coding & Translation, and Analytics to translate requirements into configuration-ready rules and to estimate financial impact, collaborating with cross-functional teams throughout the lifecycle.