Interoperability Product Owner

Role Description

The Interoperability Product Owner is responsible for ensuring compliance with interoperability mandates and legal requirements, focusing on the CMS-0057-F mandate and its expanding scope for payers. This role serves as the single point of contact bridging compliance and business teams, translating CMS implementation guides and regulatory requirements into actionable requirements for various teams.

• Lead oversight for compliance-related audits and initiatives related to interoperability.
• Participate in the Trusted Exchange Framework and Common Agreement (TEFCA) framework.
• Collaborate with internal teams to establish data sharing agreements and capabilities.
• Serve as a single point of contact between compliance and business teams.
• Educate internal teams on compliance impacts and operational changes.
• Oversee vendor and internal builds for compliance with CMS mandates.
• Drive alignment across business and IT teams on the build of FHIR endpoints.
• Ensure data readiness across claims, encounters, clinical data, and prior authorization information.
• Support prior authorization operational changes.
• Monitor and anticipate CMS's expanding mandate roadmap.
• Perform any other job-related duties as requested.

Qualifications

• Bachelor's degree is required.
• Master's degree is preferred.
• Five (5) years experience in healthcare interoperability, compliance, or regulatory environment required.
• Equivalent years of relevant work experience may be accepted in lieu of required education.

Requirements

• Strong analytical, decision making, and problem-solving skills.
• Strong understanding of HIPAA regulations, Interoperability mandates, EDI, and CMS guidelines including CMS-0057-F.
• Deep knowledge of FHIR APIs, OAuth2 security frameworks, and payer-to-payer exchange requirements.
• Ability to interpret and apply CMS implementation guides and translate regulatory requirements into business and technical requirements.
• Excellent project management skills and ability to juggle multiple priorities in a fast-paced environment.
• Ability to work across and align multiple teams including clinical operations, membership, IT, Digital, and Customer Experience.
• Strong communication and stakeholder management skills to bridge compliance and business teams.

Benefits

• Compensation range: $94,100.00 - $164,800.00.
• Potential for a bonus tied to company and individual performance.
• Comprehensive total rewards package focused on employee well-being.

Working Conditions

• General office environment; may be required to sit or stand for extended periods of time.
• Travel is not typically required.