Product Manager, Prior Authorizations
Availity
full-time
Posted on:
Location Type: Remote
Location: United States
Visit company websiteExplore more
About the role
- Define and communicate a clear product roadmap aligned with CMS requirements, industry trends, and organizational goals
- Gather and document business requirements through stakeholder interviews and workflow analysis
- Translate requirements into user stories, acceptance criteria, and API specifications for engineering teams
- Validate interoperability standards (X12 278, FHIR CRD/DTR/PAS) for transactions between EHRs, Availity, and payer/vendor systems
- Collaborate with engineering, data, and delivery teams to ensure timely, compliant, and scalable product releases
- Serve as the subject matter expert on prior authorization workflows and FHIR standards; provide guidance internally and externally
- Monitor CMS mandates, industry trends, and client feedback to inform product decisions and prioritize features
- Lead pilots, define KPIs/OKRs, and drive successful go-to-market strategies
- Define product performance metrics and partner with data teams to deliver actionable insights for ROI and gainshare
- Align executives, clients, and internal teams on product vision, progress, and outcomes
Requirements
- Minimum of 5 years’ experience in Product Management preferably with client facing experience within healthcare technology
- Deep expertise in prior authorizations workflows
- Strong technical background with an understanding of the CMS 0057-F requirements for prior authorization and the X12 278 EDI and FHIR prior authorization (CRD, DTR, and PAS) transactions
- Knowledge of EHR systems and utilization management platforms and vendors
- Technical acumen, ability to gather and describe market requirements and get feedback from technical staff and customers
- Business acumen: ability to contribute to a business case, evaluate feasibility & scalability, and driving ROI
- Familiarity with regulatory requirements and compliance standards
- Proven ability to lead cross-functional initiatives and influence stakeholders
Benefits
- Competitive salary
- Bonus structure
- Generous HSA company contribution
- Healthcare benefits
- Vision benefits
- Dental benefits
- 401k match program on day one
- Unlimited PTO for salaried associates + 9 paid holidays
- 19 days of PTO for hourly associates
- Gym membership reimbursement up to $250/year
- Education reimbursement
- Paid Parental Leave for both moms and dads
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
product roadmapuser storiesacceptance criteriaAPI specificationsinteroperability standardsX12 278FHIR CRDFHIR DTRFHIR PASprior authorization workflows
Soft skills
stakeholder interviewsworkflow analysiscollaborationguidancemonitoring trendsdefining KPIsdriving strategiesaligning teamsinfluencing stakeholdersbusiness case evaluation