Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The Technical Product Manager role for Provider solutions merges product management, healthcare exper-tise, and technical knowledge to develop and manage software and technology products for Medicare provid-ers. Technical Product Managers work with business stakeholders and engineering teams to translate com-plex regulatory and operational requirements into actionable technical solutions. This role will drive the strat-egy, roadmap, and delivery of Provider software solutions. The Technical Product Manager will ensure the platform delivers scalable, compliant, and efficient solutions to support Medicare claims adjudication, pay-ment timeliness and accuracy.Job Duties/Responsibilities:
- Drive the functional and technical roadmap for Provider Solutions on Alignment’s AVA and Claims platforms, ensuring alignment with Medicare business priorities, CMS requirements, and enterprise technology goals.
- Anticipate regulatory and operational changes (e.g., CMS rule updates, encounter data submission requirements) and integrate them into the roadmap.
- Lead the design, testing, and implementation of new features for Provider platforms.
- Oversee configuration of provider contracts, capitation and claims payment rules.
- Define requirements for interface integration between platforms, APIs, and EDI X12 transactions (837, 835, 277, 999) to support claims adjudication, payment, and provider portals.
- Translate CMS regulations and Medicare operational requirements into actionable business and system requirements.
- Partner with vendors to manage technical solutions and integrations, ensuring compliance with service-level agreements (SLAs).
- Monitor end-to-end Provider workflows, starting with credentialing, network adequacy and contracting through provider setup, directory accuracy and payment automation and efficiency.
- Serve as the functional-technical bridge between DTS, Business Operations and network/provider engagement teams.
Job Requirements:
Experience:
- 5+ years of Product Management or Business Analyst experience in healthcare payer systems, with at least 3 years focused on TriZetto Facets.
- Strong functional expertise in Provider contracting, capitation arrangements, claims and payment reimbursement.
- Proven hands-on expertise with:
- Microsoft SQL (querying, optimization, reconciliation, audits)
- ETL Tools such as Microsoft SSIS and Azure Data Factory
- Job Scheduling tools such as Redwood, Tidal and Control-M
- Cloud Platforms (Azure/AWS)
- Experience integrating vendor solutions.
- Solid understanding of what drives compliance in a Medicare environment.
- Strong analytical, problem-solving, and communication skills with the ability to translate technical details into business outcomes.
Education:
- Bachelor’s degree in Information Systems, Computer Science, Business, Healthcare Administration, or related field. 4 years additional experience may be considered in lieu of education.
- MBA or advanced degree preferred.
Specialized Skills:
- Deep understanding of Provider Credentialing, Contracting and Reimbursement Strategies in a Medicare environment.
- Proficiency in relevant technical tools, such as SQL, Azure Data Factory, Jira, and Confluence.
- Experience in defining product strategies, managing product backlogs, and working within agile development methodologies.
- Familiarity with EDI standards and file protocols (HIPAA 837/835/820, XML, PDF fulfillment).
- Vendor management and SLA performance oversight.
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].
Top Skills
What We Do
Alignment Healthcare is redefining the business of health care by shifting the focus from payments to people. We’ve created a new model for health care delivery that cuts costs and improves lives by unraveling the inefficiencies of the current system to drive patients, providers and payers toward a common goal of wellness. Harnessing best practices from Medicare Advantage, our innovative data-management technology allows us to commit to caring for seniors and those who need it most: the chronically ill and frail. Alignment Healthcare provides partners and patients with customized care and service where they need it and when they need it, including clinical coordination, risk management and technology facilitation. Alignment Healthcare offers health plan options through Alignment Health Plan, and also partners with select health plans to help deliver better benefits at lower costs. For more information, please visit www.alignmenthealthcare.com.
