Sr. Product Manager- Pre Pay Solutions

PLEASE NOTE BEFORE APPLYING:

CODOXO IS NOT ABLE TO OFFER SPONSORSHIP OR ACCOMMODATE ANY CANDIDATES THAT ARE CURRENTLY BEING SPONSORED NOW OR IN THE FUTURE

Of the $3.8T we spend on healthcare in the United States annually, about a third of it is estimated to be lost due to waste, fraud and abuse. Codoxo is the premier provider of artificial intelligence-driven solutions and services that help healthcare companies and agencies proactively detect and reduce risks from fraud, waste, and abuse and ensure payment integrity. Codoxo helps clients manage costs across network management, clinical care, provider coding and billing, payment integrity, and special investigation units. Our software-as-a service applications are built on our proven Forensic AI Engine, which uses patented AI-based technology to identify problems and suspicious behavior far faster and earlier than traditional techniques.

We are venture backed by some of the top investors in the country, with strong financials, and remain one of the fastest growing healthcare AI companies in the industry.

Position Summary:

Codoxo's pre-pay solutions help health plans find fraud, waste and abuse in claims before they are paid, so that improper payments are stopped at the front end instead of recovered later. As Senior Product Manager, you own the direction and roadmap for our pre-pay solutions. You decide what we build, why, and in what order. You are the domain expert for pre-payment FWA. This role requires hands-on pre-payment review experience.

Key Responsibilities:

• Set the vision and roadmap for our pre-pay solutions, based on customer needs, emerging FWA schemes, regulatory direction and company goals.
• Define how pre-payment detection works: which claims are held or flagged, how reviewers see and resolve them, and how decisions are recorded and audited.
• Run discovery with customers, SIU and payment-integrity teams, SMEs, Customer Success and Sales.
• Write functional specs and break them into releasable stories that engineering can build and QA can test.
• Work with the Senior Designer on prototypes, and use SME and developer reviews to improve the design and spec before development starts.
• Define success measures for each release (hold accuracy, false positive rate, provider abrasion, savings, turnaround time), follow them after launch and act on the results.
• Work with engineering, data science, clinical and payment-integrity SMEs and the Technical Writer to deliver on time.
• Support implementations, demos and renewals as the product expert, and report status, risks and trade-offs to leadership.

Qualifications:

• Prior experience in health care payment integrity and FWA, including at least 5 years of hands-on pre-payment review (pre-payment claim review, pre-payment edits, payment suspension, PI workflows). Pre-payment review is a must-have.
• 10 or more years in product management, or equivalent experience owning a product or solution, including 3 or more in B2B enterprise software.
• Working knowledge of claim adjudication and payment, and of claim formats and code sets (837, CPT/HCPCS, ICD-10).
• Understanding of the compliance, provider-dispute and audit concerns that apply when a claim is held or denied before payment.
• A record of taking features from discovery to shipped release, with specs and stories that development teams can work from.
• Comfort with data: you can read claims and model outputs and define metrics for a decision workflow.
• Clear written communication.
• Experience with ML-assisted detection and how to measure it.
• Experience with workflows where an automated system and a human reviewer share the decision.
• Experience implementing for health plans, TPAs or government programs.
• Remote Work Requirements: To ensure reliable performance on the company-issued CODOXO laptop, employees working remotely must have a stable high-speed internet connection. Internet performance should be measured using a speed test conducted directly on the CODOXO laptop, not based solely on the internet plan purchased from the provider.
• Physical Requirements: Work is performed in an office environment (either in our office or work-from home) and requires the ability to work on a computer, operate standard office equipment, and work at a desk.

Accessibility Notice: If you need reasonable accommodation for any part of the employment process due to a physical or mental disability, please send an email to careers@codoxo.com with the subject "Accommodation". Reasonable accommodation requests will be considered on a case-by-case basis.

Benefits for You

Health, Dental, and Vision insurance with 100% employee premium coverage (Starts Day 1)

Unlimited PTO

Annual Professional Development stipend

Annual home office stipend

401K Match (after 90 days)

We are an Equal Opportunity Employer:

Codoxo provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment.