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 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 $128,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.
Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.
Date of posting: 8/19/2026
Applications are assessed on a rolling basis. We anticipate that the application window will close on 10/19/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.
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