Product Manager, Medicare Provider Data Management

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Product Manager, Medicare Provider Data Management in the United States.

This role sits at the intersection of healthcare regulation, provider data governance, and product strategy, focusing on how provider information is structured, validated, and maintained within a complex payer platform. You will own critical product capabilities that ensure health plans comply with CMS Medicare Fee-for-Service requirements while maintaining accurate, reliable provider directories and clean claims processing. Working in a highly collaborative, cross-functional environment, you will translate evolving regulatory mandates into scalable product solutions used by health plans nationwide. This position requires strong fluency in CMS standards, provider data workflows, and healthcare interoperability frameworks. You will partner closely with engineering, implementation, QA, and client success teams to ensure product functionality aligns with real-world operational and compliance needs. The role is ideal for someone who thrives in regulated healthcare environments and enjoys turning complex policy requirements into structured, scalable product design. Your work will directly impact compliance, operational efficiency, and patient-provider data accuracy across the healthcare ecosystem.

This role is responsible for defining and evolving provider data management capabilities within a healthcare payer platform, ensuring full alignment with CMS Medicare requirements and industry standards.

• Define and manage product requirements for provider data standards including NPI validation, taxonomy classification, specialty mapping, and provider file maintenance aligned with CMS guidelines.
• Translate CMS regulatory updates (PECOS, enrollment, revalidation cycles, taxonomy changes) into structured product requirements, user stories, and backlog priorities.
• Ensure provider data workflows support accurate enrollment, credentialing, directory accuracy, and claims processing within Medicare Fee-for-Service environments.
• Design and refine provider data ingestion, validation, reconciliation, and exception-handling processes within the platform.
• Partner with implementation and client success teams to identify compliance gaps and drive remediation through product enhancements.
• Serve as the subject matter expert for provider data governance, collaborating with engineering and QA to ensure accurate delivery and issue resolution.
• Support alignment of provider data structures with downstream operational needs including pricing, claims routing, and network adequacy reporting.

Requirements

This role requires deep healthcare payer expertise, strong regulatory fluency, and the ability to translate CMS provider data standards into scalable product solutions.

• 5+ years of product management or equivalent experience in healthcare payer operations, provider data management, or network/credentialing environments.
• Deep knowledge of CMS Medicare Fee-for-Service provider standards, including PECOS enrollment, NPI registry processes, and revalidation requirements.
• Strong understanding of HIPAA provider data standards, taxonomy codes, and provider file transaction structures used in healthcare claims systems.
• Experience translating regulatory and compliance requirements into product specifications, user stories, and Agile development workflows.
• Familiarity with provider directory accuracy requirements, network adequacy standards, and credentialing lifecycle processes.
• Strong collaboration and communication skills, with the ability to align technical and non-technical stakeholders around complex data requirements.
• Experience with healthcare provider data governance, master data management (MDM), or related frameworks is highly desirable.

Benefits

• Competitive base salary with potential for performance-based adjustments
• Comprehensive medical, dental, and vision insurance coverage
• Flexible remote work environment supporting cross-time-zone collaboration
• Paid time off and holiday benefits
• Retirement savings plan with employer contribution options
• Professional development and growth opportunities in healthcare technology
• Inclusive workplace culture committed to diversity and equal opportunity