Overview
The Product Manager leads the strategy, design, and delivery of solutions for Medicare, Medicaid, and ACA Risk Adjustment programs. The role partners with cross‑functional teams to improve documentation accuracy, optimize risk capture, and ensure compliance with CMS and state requirements. A key focus is enabling interoperable data exchange across clinical and administrative systems. The ideal candidate has strong expertise in risk models, coding workflows, and interoperability standards to deliver products that enhance outcomes and business performance.Responsibilities
- Partner with enterprise and customer stakeholders to identify opportunities to improve risk score accuracy, data completeness, and work-flow efficiency.
- Define risk adjustment product use cases and validate them through work-flow analysis and VOC sessions.
- Translate CMS, HHS, and state regulatory changes into actionable product requirements and road-map updates.
- Drive interoperability‑focused product design, ensuring EHR/EMR and clinical data exchange supports risk adjustment work-flows and regulatory needs.
- Collaborate with engineering, clinical, and data teams to design scalable RA solutions, including suspecting models, chart review work-flows, coding tools, clinical ingestion pipelines, and other modules.
- Evaluate RA use cases to determine appropriate AI/ML, automation, and work-flow optimization approaches.
- Own the voice of the customer, pro-actively gathering feedback to drive adoption and continuous improvement.
- Build ROI models and product business cases for new features, analytics, or interoperability enhancements.
- Guide analytics teams on exploratory RA analysis and identify what can be operationalized into scalable product capabilities.
- Ensure RA solutions support interoperability compliance.
- Support implementations and program year transitions, ensuring configuration changes are successfully deployed.
- Contribute to long-term product strategy, emphasizing scalability, interoperability, automation, and regulatory readiness.
- Complete all responsibilities as outlined in the annual performance review and/or goal setting.
- Complete all special projects and other duties as assigned.
- Must be able to perform duties with or without reasonable accommodation.
This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.
Qualifications
- Bachelor's degree with strong academic performance in Health Sciences, Computer Science, Engineering, Economics, Mathematics, or another quantitative field.
- 3+ years of experience in healthcare product management, analytics, consulting, or technology, including 2+ years developing risk adjustment products.
- Demonstrated knowledge of risk adjustment and interoperability frameworks.
- Strong understanding of:
- CMS-HCC, HHS-HCC, and Medicaid Risk Adjustment models
- EHR/EMR data and clinical interoperability
- Clinical documentation, coding workflows, and provider specialty taxonomy
- Prospective and retrospective RA programs
- Experience working with cross-functional, matrixed product teams in an agile environment; agile or other product management certifications a plus.
- Experience defining customer workflows and user stories; UI/UX skills a plus.
Cognitive / Mental Requirements:
- Excellent communication and stakeh