Product Manager

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,optimizerisk 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 strongexpertisein risk models, coding workflows, and interoperability standards to deliver products that enhance outcomes and business performance. Responsibilities Partner withenterprise and customerstakeholders toidentifyopportunities to improve risk score accuracy, data completeness, and work-flowefficiency. Define riskadjustmentproduct use casesandvalidatethem through work-flowanalysis and VOC sessions. Translate CMS, HHS, and state regulatory changes into actionable product requirements and road-mapupdates. Drive interoperability‑focused product design, ensuring EHR/EMR and clinical data exchange supports risk adjustment work-flowsand 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, andothermodules. Evaluate RAuse casesto determineappropriate AI/ML, automation, and work-flowoptimization approaches. Own the voice of the customer, pro-activelygathering 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 andidentifywhat 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, oranotherquantitative field. 3+ years of experience in healthcare product management, analytics, consulting, or technology, including 2+ yearsdeveloping 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 stakeholder management abilities. Able to translate regulatory/clinical requirements into technical solutions and explain technical concepts to non‑technical audiences. Strong problem‑solving mindset and a track record of driving initiatives from concept to implementation. Leadership and mentorship capabilities are essential – this role will guide teams and represent Cotiviti’s interoperability expertise both internally and externally, so the candidate should be comfortable taking initiative, “leading without authority” when required, and mentoring others. Physical Requirements and Working Conditions: Remaining in a stationary position, often standing or sitting for prolonged periods. Repeating motions that may include the wrists, hands, and/or fingers. Must be able to provide a dedicated, secure work area. Must be able to provide high‑speed internet access/connectivity and office setup and maintenance. Base compensation ranges from$103,000 to$128,000per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. medical dental vision disability life insurance coverage 401(k) savings plans paid family leave 9 paid holidays per year 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti Date of posting: 8/19/2026 #J-18808-Ljbffr