RCM Product Manager - (US Shift)

Product Owner — Revenue Cycle Management (Claims & Full RCM)

About the role :

Core mandate :

• Maintain a single, prioritized, groomed claims backlog — epics, stories, spikes, and defects in one ranked order
• Write acceptance criteria precise enough for engineering to build and QA to test without a follow-up meeting
• Run grooming, sprint planning, daily standups, reviews, and retros; keep sprints scoped and predictable
• Make the tactical trade-off calls in-sprint — scope cuts, sequencing, "ship now vs. fix now" — and escalate only what genuinely needs the VP

• Translate roadmap intent into EDI-level specs: 837D claim construction, 277CA rejection handling, 835 posting and adjustment logic, 270/271 eligibility reuse, attachment payloads and payer requirements
• Document payer-specific edits, frequency limitations, downgrade and COB rules as testable business rules — not prose
• Own the exception taxonomy: what fails, where it queues, who touches it, and what the resolution path is
• Keep specs current as payer and clearinghouse behavior changes in the field

• Define release scope, entry/exit criteria, and go/no-go signals
• Build and execute test plans with QA, including EDI validation, payer sandbox testing, and end-to-end claim-to-cash regression
• Run design-partner pilots: recruit practices, define success criteria, sit in on live usage, close the loop on findings
• Own phased rollout, feature flags, migration plans, and rollback conditions
• Write release notes, training material, and enablement content for Implementation, Support, and Sales

• Triage incoming defects and escalations daily; own severity calls and turnaround commitments
• Monitor the operational dashboards — rejection rates, posting failures, queue depth, SLA breaches — and act before customers report
• Run root-cause reviews on production incidents and drive the fix into the backlog
• Be the escalation point of record for claims issues across Support and Operations

• Work with offshore RCM operations to define what the software automates and what a human still touches
• Instrument touch rate per claim and drive it down release over release
• Build the tooling, queues, and audit trails the ops team needs to work efficiently

• Day-to-day technical coordination with clearinghouse partners: integration scope, testing cycles, enrollment flows, ticket escalation, certification milestones
• Feed real utilization and cost data (claims per location, attachment attach rate, per-transaction spend) back to the VP for pricing and contract decisions
• Commercial terms and partner selection sit with the VP of Product; you own delivery against them.

What we're looking for :

• 4–8 years as a Product Owner, Business Analyst, or delivery-focused PM on healthcare RCM, claims, clearinghouse, or medical/dental billing products
• Working fluency in X12 EDI — 837, 835, 270/271, 277CA. You can read a rejection code, trace it to the loop and segment, and write the story to fix it
• Understanding of payer adjudication mechanics: plan design, frequency limitations, downgrades, coordination of benefits, bundling
• Demonstrated ownership of a backlog in an Agile/Scrum environment; comfortable running ceremonies and holding a team to a sprint commitment
• Exceptional written precision — acceptance criteria, business rules, and edge cases are your primary output
• SQL or equivalent data fluency; you pull your own numbers to triage a defect or size an issue
• Composure under production pressure; you can run an escalation without escalating

• Dental-specific background: CDT coding, dental attachments (NEA/FastAttach or payer-direct), dental payer quirks
• Hands-on experience integrating with a clearinghouse (Vyne, DentalXChange, Change/Optum, Availity, Stedi) including enrollment and certification cycles
• Experience working with offshore operations teams as part of the delivery model
• Exposure to AI/ML-assisted workflows — claim scrubbing, denial prediction, or auto-remediation
• CSPO/CSM or equivalent; experience with Jira/Asana-based delivery at scale

What success looks like :

How we'll evaluate you

• Sprint predictability and release quality
• Defect escape rate and time-to-resolution on production escalations
• Straight-through processing rate and manual touch per claim
• Design-partner adoption and time-to-first-successful-claim for new practices
• Spec quality, measured by how few clarification cycles engineering and QA need

Why this role

• A clear, funded roadmap and an existing revenue base — you execute against direction, not ambiguity
• Real ownership of the delivery machine: backlog, release, quality, and rollout are all yours
• Deep domain work in a space where getting the details right is the entire product