Director Of Product Management Of Claims Pricing

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As the Director of Product Management ofClaims Pricing, you will be tasked with overseeing a product delivery of Claims Pricing and all other pricing methodology. You will work across multiple product lines for a holistic solution that manages out-of-network utilization and patient experience. You will be responsible for understanding the needs of the enterprise pricing strategy and partner with Analytics team and Provider strategy & initiative teams, developing a supporting product roadmap and overseeing execution against the roadmap. Your overarching focus will be on managing the prioritization of research and development of pricing methodology and build scaled capability based on business needs and technical and regulatory constraints. This position requires a motivated self-starter who has the flexibility and versatility to pivot to adjust to evolving business needs. The Director of Capability Management reports to the Senior Director of Product.

Primary Responsibilities:

• Create and drive increment product and capability roadmap based on business strategy, a prioritization process, and key objectives.

• Collaborate with Provider strategy and Analytics teams to ensure Claims Pricing strategy alignment.

• Collaborate with other product team leaders to ensure seamless integration and function conflicts and redundancy

• Own the overall execution against the product roadmap, managing scope, timelines and stakeholder expectations

• Conduct financial and pricing modeling, analysis and reporting

• Influence pricing strategies and pricing package configuration decisions using a data driven approach

• Provide consultative advice on use of data as subject matter expert and interpret / summarize analytical findings

• Lead the development of strategic initiatives aimed at reducing the total cost of care

• Work collaboratively with cross-functional teams including product value creation, program management, technology, legal, and other internal teams to execute your roadmap

• Establish and analyze key metrics to help make product decisions

• As necessary, own development team priorities and supply them with use cases, business requirements, and personas that reflect constituent expectations and needs and best practices

• Ensure legal and regulatory compliance

Daily Practices:

• Ability to think strategically and execute methodically

• Strong interpersonal, communication and management skills

• Strong analytical, project management and problem-solving skills

• Ability to think creatively and comfort being hands-on in a fast-paced, entrepreneurial environment

• High attention to detail including ability to manage multiple, competing priorities simultaneously

• Willingness to roll up your sleeves and do whatever is necessary; general manager / owner mentality

Required Qualifications:

• Bachelor’s degree required

• 7+ years of experience with provider payment methodologies like DRG, CMS, Fair health etc.

• 5+ years of experience with product or capability development through entire product lifecycle

• 5+ years of experience working with complex claims data and deep understanding claims billing included knowledge of CPT, HCPCS, Rev codes and ICD 10 codes.

• 3+ years using product development and agile principles

Preferred Qualifications:

• MBA or equivalent

• Experience managing technical teams

• Experience in products or capabilities

• Excellent verbal and written communication skills including MS