Principal Product Manager, Claims and Encounters
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Job Location:
Sacramento, CA - USA
Monthly Salary:
Not Disclosed
Posted on:
2 hours ago
Vacancies:
1 Vacancy
Job Summary
Job Title:Principal Product Manager Claims and Encounters
Location: Remote(Working hours are Monday-Friday PST)
Division: Medical Enterprise System Modernization Division (MESMD) Behavioral Health Transformation Project (BHT)
Department: California Department of Health Care Services (DHCS)
Must work on shore in the US. We cannot sponsor or transfer an H1B Visa for this role.
About the Behavioral Health Transformation (BHT) InitiativeCalifornias behavioral health system is undergoing one of the most significant transformations in its history. Driven by new legislationincluding the Behavioral Health Services Act and related reformsDHCS is working to modernize how behavioral health services are delivered tracked and improved across the state.
The BHT initiative is a multi-year effort to re-architect the way DHCS partners with counties and providers to deliver care measure outcomes and produce transparency andaccountability. This work requires a new generation of digital tools data infrastructure and service delivery models.At its core BHT is about making real changes in the lives of Californiansensuring every dollar spent can be tied to improved access quality and health outcomes.
We areseekinga strong multidisciplinaryPrincipal Product Manager todrivethe modernization of our claims and encounter capabilities supporting Behavioral Health Transformation (BHT).
While DHCS receives claims and encounter submissions today the systems are fragmented and lack transparency for counties providers and managed care plans. We are building user-facing operational software that enablessubmittingentities to directly manage submission quality reconciliation status and reporting accuracy and to be accountable for the integrity of their data.
This role requires deep hands-on experience owning Medicaid claims and encounter systems. The ideal candidate understands adjudication workflows CMS reporting requirements healthcare interoperability standards and how operational systems drive accountability.
Statement for Speridian Technology
Speridian Technology is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin disability protected veteran status or any other characteristic protected by law. Reasonable accommodations are available for qualified individuals with disabilities during the application process.
This is a senior individual contributor roleoperatingand owning outcomesat the intersection of policy operations data standards compliance and engineering.
WhatYoullDo
- Translate the strategic requirements for BHT operational systems into an executable roadmap aligned to statutory deadlines.
- Own roadmap prioritization epics and user stories and ensureadherencetoall technical delivery standards.
- Work directly with operations and data policy teams to transformstate and federalfinancial andaccountabilityreporting obligations into clear implementable product requirements.
- Ownthe modernization and userexperienceofexternal-facing claims and encounters management software enabling submission validation reconciliation transparencyaccountabilityandcompliance.
- Design user workflows thatimprove data quality at the source andgive counties providers managed care plans and DHCS visibility into submission status data qualitystateand federal compliance.
- Coordinate and drive the development of enterprise business process maps data models andtechnicalarchitecturewithpolicy data and engineering partners.
- Ensure claims and encounter systems integrateseamlessly with Medical Enterprise Systems.
- Define measurable outcomes tied to compliance timeliness reconciliation accuracy and operational performance
Required Experience
Candidates mustdemonstrate:
- 10 years of product management experience in healthcare technology
- Direct ownership of Medicaid or government healthcare claims and/or encounter systems
- Deep understanding of:
- Claims adjudication workflows
- Managed care encounter reporting
- CMS Medicaid reporting requirements
- CPT/HCPCS/ICD coding structures
- Substantial experience with healthcare data standards including:
- USCDI
- HL7 / FHIR APIs
- Standard code sets and validation frameworks
- Experience translating regulatory and reporting requirements into system functionality
- Experienceoperatingwithin California state reporting environments strongly preferred
- Experience modernizing orconsolidatingfragmented claims orencountersystems
- Experience building submission engines validation services or transaction gateways
- Familiarity with MITA and Medicaid Enterprise modernization
- Experience enabling user-facing operational tools that improve data quality and compliance
- Experience working in complex public-sector or managed care environments
What Success Looks Like
- Submitting entities have clear visibility into claims and encounter status and data quality
- Validation and reconciliation workflows are transparent and standardized
- Data quality improves at the point of submission rather than through downstream correction
- Claims and encounter capabilities integrate cleanly with other DHCS operational systems
- Operational accountability across delivery systems measurably increases
Why This Role Matters
Claims and encounter systems are foundational to Medi-Cal oversight reporting and payment integrity. Modernizing these capabilities enables transparency improves data quality at the source and strengthens accountability across Californias behavioral health delivery system.
Required Experience:
Staff IC
Key Skills
- Time Management
- Data Analytics
- Analytical
- Agile
- Requirement Gathering
- Strategic thinking
- Visio
- Communication
- Problem Solving
- Market Research
- UML
- Cross Functional Teams
About Company
We at Speridian Technologies provide IT solutions and help our clients modernize their businesses through Digital Transformation.
