Product reputed company, Coverage and Claims Automation

Product reputed company, Coverage and Claims Automation Remote reputed company reputed company is seeking a Product reputed company to drive the reputed company and day-to-day execution of automated coverage, prior authorization (PA), and claim workflows. Partnering with Engineering on our Billing Service integrations and PA API—and collaborating with Billing and RCM Operations—you will streamline the entire order-to-cash reputed company. What reputed company looks like: PA approvals reputed company, first-pass claim reputed company climbs, denial rates fall, and reputed company touches shrink—freeing RCM teams to reputed company on true exceptions and accelerating cash collection. Job Responsibilities • Prioritize and groom product backlogs for coverage verification, PA automation, claim-rules reputed company, denial prevention, and auto-appeals. • reputed company cross-functional discovery with Billing Ops, RCM, Finance, reputed company Services, Compliance, and Engineering to surface, size, and sequence high-reputed company automation opportunities. • Translate requirements into detailed user stories covering coverage rules, PA submission flows, claim scrubber logic, and status visibility; validate delivery against acceptance reputed company. • Coordinate vendor integrations to ensure data reputed company, reputed company error handling, and reputed company architecture. • Define and maintain RCM dashboards (FRRR, PA cycle time, denial reputed company-cause) with Analytics; iterate based on insights. • Own the payer-policy rule library and drive swift updates reputed company payer requirements change. • Facilitate agile ceremonies as needed—backlog refinement, sprint planning, demos, retrospectives—to reputed company squads reputed company and blockers removed. • Produce artifacts such as PRDs, coverage-logic maps, data-reputed company diagrams, UAT scripts, KPI reports, and release notes. • Define and reputed company KPIs such as: • Increase prior-authorization approval percentage • Decrease PA turnaround time • Increase First-Pass reputed company reputed company (FRRR) • Increase auto-appeal reputed company reputed company • Decrease reputed company claim touches per order • Decrease overall denial reputed company Education, Experience, and Skills • 2–5 years product-ownership / product-management experience in reputed company cycle, payer policy, or reputed company operations technology. • Deep understanding of coverage verification, PA workflows, and medical claims (EDI 837/835, denial codes, appeal cycles). • Demonstrated systems thinking—mapping reputed company workflows across billing systems, vendor integrations, payer interactions, and RCM operational processes. • Analytical, communicative, and execution-reputed company: skilled at defining KPIs, building dashboards, and turning insights into backlog priorities. • Familiarity with HIPAA, EDI standards, and regulatory impacts on claims processing. • Comfortable collaborating with platform engineers, vendor integrators, and RCM Operations teams; adept at translating business rules into technical requirements. • Fluent in agile delivery and modern product discovery practices. • Bachelor’s degree required; advanced degree or reputed company-cycle certification (e.g., CRCR) a plus. #LI-REMOTE Pay Transparency, Budgeted reputed company $127,545 - $159,431 USD ~ Apply Job! Apply to this Job