Product Owner, Coverage and Claims Automation
Product Owner, Coverage and Claims Automation
Remote
Summary
GeneDx is seeking a Product Owner to drive the strategy and day-to-day execution of automated coverage, prior authorization (PA), and claim workflows. Partnering with Engineering on our Billing Service integrations and PA API—and collaborating with Billing and RCM Operations—you will streamline the entire order-to-cash journey.
What success looks like: PA approvals rise, first-pass claim resolution climbs, denial rates fall, and manual touches shrink—freeing RCM teams to focus on true exceptions and accelerating cash collection.
Job Responsibilities
• Prioritize and groom product backlogs for coverage verification, PA automation, claim-rules engine, denial prevention, and auto-appeals.
• Lead cross-functional discovery with Billing Ops, RCM, Finance, Client Services, Compliance, and Engineering to surface, size, and sequence high-impact automation opportunities.
• Translate requirements into detailed user stories covering coverage rules, PA submission flows, claim scrubber logic, and status visibility; validate delivery against acceptance criteria.
• Coordinate vendor integrations to ensure data integrity, timely error handling, and scalable architecture.
• Define and maintain RCM dashboards (FRRR, PA cycle time, denial root-cause) with Analytics; iterate based on insights.
• Own the payer-policy rule library and drive swift updates when payer requirements change.
• Facilitate agile ceremonies as needed—backlog refinement, sprint planning, demos, retrospectives—to keep squads aligned and blockers removed.
• Produce artifacts such as PRDs, coverage-logic maps, data-flow diagrams, UAT scripts, KPI reports, and release notes.
• Define and track KPIs such as:
• Increase prior-authorization approval percentage
• Decrease PA turnaround time
• Increase First-Pass Resolution Rate (FRRR)
• Increase auto-appeal success rate
• Decrease manual claim touches per order
• Decrease overall denial rate
Education, Experience, and Skills
• 2–5 years product-ownership / product-management experience in revenue cycle, payer policy, or healthcare operations technology.
• Deep understanding of coverage verification, PA workflows, and medical claims (EDI 837/835, denial codes, appeal cycles).
• Demonstrated systems thinking—mapping complex workflows across billing systems, vendor integrations, payer interactions, and RCM operational processes.
• Analytical, communicative, and execution-focused: skilled at defining KPIs, building dashboards, and turning insights into backlog priorities.
• Familiarity with HIPAA, EDI standards, and regulatory impacts on claims processing.
• Comfortable collaborating with platform engineers, vendor integrators, and RCM Operations teams; adept at translating business rules into technical requirements.
• Fluent in agile delivery and modern product discovery practices.
• Bachelor’s degree required; advanced degree or revenue-cycle certification (e.g., CRCR) a plus.
#LI-REMOTE
Pay Transparency, Budgeted Range
$127,545 - $159,431 USD
~
Apply Now
Apply Now
Remote
Summary
GeneDx is seeking a Product Owner to drive the strategy and day-to-day execution of automated coverage, prior authorization (PA), and claim workflows. Partnering with Engineering on our Billing Service integrations and PA API—and collaborating with Billing and RCM Operations—you will streamline the entire order-to-cash journey.
What success looks like: PA approvals rise, first-pass claim resolution climbs, denial rates fall, and manual touches shrink—freeing RCM teams to focus on true exceptions and accelerating cash collection.
Job Responsibilities
• Prioritize and groom product backlogs for coverage verification, PA automation, claim-rules engine, denial prevention, and auto-appeals.
• Lead cross-functional discovery with Billing Ops, RCM, Finance, Client Services, Compliance, and Engineering to surface, size, and sequence high-impact automation opportunities.
• Translate requirements into detailed user stories covering coverage rules, PA submission flows, claim scrubber logic, and status visibility; validate delivery against acceptance criteria.
• Coordinate vendor integrations to ensure data integrity, timely error handling, and scalable architecture.
• Define and maintain RCM dashboards (FRRR, PA cycle time, denial root-cause) with Analytics; iterate based on insights.
• Own the payer-policy rule library and drive swift updates when payer requirements change.
• Facilitate agile ceremonies as needed—backlog refinement, sprint planning, demos, retrospectives—to keep squads aligned and blockers removed.
• Produce artifacts such as PRDs, coverage-logic maps, data-flow diagrams, UAT scripts, KPI reports, and release notes.
• Define and track KPIs such as:
• Increase prior-authorization approval percentage
• Decrease PA turnaround time
• Increase First-Pass Resolution Rate (FRRR)
• Increase auto-appeal success rate
• Decrease manual claim touches per order
• Decrease overall denial rate
Education, Experience, and Skills
• 2–5 years product-ownership / product-management experience in revenue cycle, payer policy, or healthcare operations technology.
• Deep understanding of coverage verification, PA workflows, and medical claims (EDI 837/835, denial codes, appeal cycles).
• Demonstrated systems thinking—mapping complex workflows across billing systems, vendor integrations, payer interactions, and RCM operational processes.
• Analytical, communicative, and execution-focused: skilled at defining KPIs, building dashboards, and turning insights into backlog priorities.
• Familiarity with HIPAA, EDI standards, and regulatory impacts on claims processing.
• Comfortable collaborating with platform engineers, vendor integrators, and RCM Operations teams; adept at translating business rules into technical requirements.
• Fluent in agile delivery and modern product discovery practices.
• Bachelor’s degree required; advanced degree or revenue-cycle certification (e.g., CRCR) a plus.
#LI-REMOTE
Pay Transparency, Budgeted Range
$127,545 - $159,431 USD
~
Apply Now
Apply Now