Job description

Veradigm Comprehensive Submissions (VCS) is how health plans get complete, accurate, and defensible data to regulators. Encounter and supplemental data submissions sit at the point where clinical data, claims data, revenue, and audit exposure all meet. A submission that is late, incomplete, or unsupported by the medical record shows up as lost risk-adjusted revenue, a failed audit, or a corrective action plan. As Principal Product Manager for VCS, you own the most complex and strategically significant problems in that portfolio. You are the person the company relies on to know what CMS, HHS, state Medicaid agencies, and NCQA actually require, when those requirements change, and what that change means for our roadmap and for our clients financial and compliance outcomes. This is a hands-on principal individual-contributor role on an empowered product team. You will spend your time with health plan risk adjustment leaders, compliance officers, and submissions operations teams; in the regulations and technical specifications themselves; and with your engineering and design partners deciding what to build. You will set the standard for continuous discovery and outcome accountability across the submissions portfolio, and you will coach other product managers on regulatory product craft. Regulatory depth is the core requirement for this role. We are looking for someone who has personally lived through submission cycles, sweeps deadlines, error reconciliation, and audit response, and who can turn that experience into product. What You ll Contribute: Regulatory and Compliance Ownership Serves as the company s authority on encounter and supplemental data submission requirements across Medicare Advantage, commercial ACA, Medicaid, and quality reporting; owns the product interpretation of the rules and defends it to clients, auditors, and executives. Monitors and interprets regulatory change, including CMS Advance Notices and Rate Announcements, HHS Notice of Benefit and Payment Parameters, EDGE server business rules and interface control documents, state Medicaid companion guides, and NCQA HEDIS technical specifications; converts change into assessed, prioritized, and dated roadmap commitments. Owns compliance readiness for the portfolio: submission deadline and sweeps calendars, data validation and audit trail requirements, record retention, and the evidence a plan needs to substantiate submitted data during RADV, HHS-RADV, or state audit. Partners with Legal, Privacy, Compliance, and Security on HIPAA, HITRUST, and SOC 2 obligations affecting protected health information in submission workflows, and on client-facing attestations and audit responses. Establishes the accuracy, completeness, and timeliness measures the portfolio is held to, including acceptance and rejection rates, error resolution cycle time, and reconciliation of submitted data against payer-reported response files. Product Strategy and Outcomes Defines and owns accountability for business and customer outcomes across the VCS portfolio; establishes the success metrics and outcome frameworks that guide discovery and delivery, and reports honestly against them. Defines multi-year strategy and roadmap for submissions, anchored in where regulation, payer economics, and interoperability are heading rather than in current feature parity. Builds and maintains the competitive and buy-versus-build picture across risk adjustment and submissions vendors; makes explicit recommendations on where Veradigm should differentiate, partner, or exit. Influences product strategy beyond direct scope, particularly where submissions intersect with risk adjustment analytics, care gap closure, provider data exchange, and Veradigm s clinical data assets. Discovery and Customer Insight Leads continuous discovery with health plan risk adjustment, compliance, quality, and submissions operations leaders; designs research, prototype, and data experiments that validate high-stakes regulatory bets before engineering effort is committed, and sets the discovery standard for the team. Defines the approach for assessing and mitigating the four product risks (value, usability, feasibility, and business viability) on initiatives where a wrong answer creates regulatory exposure, and coaches senior product staff on applying it. Develops and maintains deep working knowledge of the customer, the data, the business, and the market; is recognized internally and externally as the domain expert for payer submissions. Uses production and client data directly to find where submissions fail, where error volume concentrates, and where operational workarounds signal a product gap. Delivery, Launch, and Execution Champions and models the product trio with engineering and product design; drives shared decision making and coaches team leads on effective trio partnership. Leads cross-functional product development and launch from concept to delivery for the portfolio s most complex initiatives; ensures alignment across engineering, QA, professional services, and technical operations. Authors and owns technical and functional specifications for large-scale initiatives, including data mapping, transaction and file format specifications, validation logic, and error handling; translates dense regulatory constraints into requirements engineers can build against. Synthesizes and arbitrates requirements across clients, operations, compliance, and engineering for a multi-generational portfolio; resolves conflicts and drives alignment. Plans releases against immovable regulatory deadlines; manages the trade-offs and cross-organizational dependencies that come with dates the company cannot negotiate. Represents vision, strategy, roadmap, and regulatory risk to executive leadership with authority and clarity. Commercial and Market Leadership Defines and manages the product P&L within scope; sets program commitments, drives launch and go-to-market strategy with Marketing and Sales, and establishes performance baselines. Develops and manages strategic partner and vendor relationships, including clearinghouses, data aggregators, and audit and coding partners; evaluates and negotiates business and contractual arrangements. Leads client advisory boards and user groups; represents Veradigm at industry forums such as RISE, AHIP, and NCQA events, and mentors senior product staff on domain expertise and product craft. Required Qualifications: Education: Bachelor s Degree in a technical, business, health administration, or health informatics discipline, or equivalent work experience Work Experience: 10 years of relevant experience in product management, technical program management, or solutions management, with at least 5 years in healthcare payer data, risk adjustment, or regulatory submissions 5 years in a payer, payer-services, or health IT organization with direct accountability for regulated data submissions Regulatory and Submissions Experience: Candidates must bring demonstrated, hands-on depth in the majority of the following, and expert-level depth in at least two: Medicare Advantage risk adjustment and encounter data. Working knowledge of the Encounter Data Processing System (EDPS) and legacy RAPS, EDR and CRR submission and correction workflows, MAO-002 and MAO-004 response file handling, Model Output Report (MOR) and Monthly Membership Report reconciliation, risk score calculation and the CMS-HCC V28 model transition, and the Part C and Part D reporting and sweeps calendar. RADV audit support. Experience preparing for or responding to CMS Risk Adjustment Data Validation audits, including medical record retrieval and coordination, one-best-record selection, coder review workflows, discrepancy and appeal handling, and extrapolation exposure. Commercial ACA risk adjustment. Hands-on experience with the CMS EDGE server, including enrollment, medical, pharmacy, and supplemental submissions, EDGE business rules and interface control documents, RATEE and default risk adjustment charge avoidance, data submission and quality thresholds, and HHS-RADV initial validation audit and second validation audit cycles. Medicaid encounter submissions. Experience with state Medicaid managed care encounter reporting, including state-specific companion guides and file layouts, encounter acceptance and denial reconciliation, state performance and completeness standards, and T-MSIS implications. Quality and Stars reporting. Experience with HEDIS supplemental data (standard and non-standard), Electronic Clinical Data Systems (ECDS) reporting, NCQA HEDIS Compliance Audit and primary source verification, Medicare Star Ratings measure mechanics, and how clinical data feeds both quality and risk adjustment. EDI and healthcare data standards. Practical fluency with X12 837I and 837P, 835, 277CA, 999 and TA1 acknowledgments, and 834 enrollment, plus ICD-10-CM, CPT, HCPCS, LOINC, RxNorm, and NDC code sets and their annual update cycles. Clinical data and interoperability. Familiarity with HL7 v2, C-CDA, FHIR (US Core and USCDI), TEFCA and QHIN participation, and how EHR-sourced clinical data is used to support submitted diagnoses. Additional Work Experience: Track record of delivering measurable business and customer outcomes, not features shipped Experience defining product strategy and multi-year roadmaps at enterprise scope Experience leading advanced product discovery and establishing discovery practice for a team Experience managing products under hard external compliance deadlines with material financial or regulatory consequence for missing them Experience in executive stakeholder management and influencing at senior leadership level Knowledge, Skills, and Abilities: Reads primary regulatory source material directly, including the Federal Register, CMS technical specifications, and NCQA specifications, and forms an independent, defensible interpretation rather than relying on secondary summaries. Deep fluency in the empowered product team model, including outcomes over output, continuous discovery, the product trio, and the four product risks, applied at enterprise scale and used to coach senior product staff. Strong ability to define, synthesize, and manage complex requirements from multiple stakeholders across product generations. Excellent analytical and problem-solving skills; comfortable working in data directly, including SQL, to investigate submission and error patterns rather than waiting on an analyst. Solid understanding of the software product development lifecycle and experience executing it end to end. Strong verbal and written communication skills; can explain a regulatory constraint to an engineer, a technical trade-off to a compliance officer, and a strategy to a board. Sound judgment under regulatory ambiguity; distinguishes what the rule requires, what is defensible, and what is merely common practice, and says so plainly. Strong interpersonal skills and a collaborative approach; works effectively in matrixed environments. Demonstrated ability to manage multiple priorities and track work to on-time, on-budget delivery. Intellectual curiosity and a commitment to quality; approaches problems in a balanced, solutions-oriented way. Preferred Qualifications: Master s Degree, MBA, MPH, or MHA Professional certification such as CRC (AAPC Certified Risk Adjustment Coder), CPC, CHC, or CPHQ Experience shipping products used by health plan operations teams at scale, including workflow, exception handling, and audit trail design Experience with high-volume data pipelines, cloud data platforms, or SaaS multi-tenant data processing Experience applying automation or machine learning to coding, chart review, or data validation, including how to govern it in a regulated context Travel: Up to 25% travel may be required for client sites, advisory boards, and industry conferences International travel may be required Compensation for this job is subject to market conditions, geographic considerations, the candidate’s unique skills and experience, state and local laws, and budget. Our commitment to pay transparency is a testament to our dedication to creating a fair, equitable, and inclusive workplace. By continuously analyzing market trends, staying abreast of changes in state laws, and making budgetary adjustments accordingly, we strive to ensure that our compensation practices reflect the value we place on our associates’ unique contributions and support their professional growth. Enhancing Lives and Building Careers Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work and to further their professional development. Together, we are In the Network. Interested in learning more? Take a look at our Culture , Benefits , Early Talent Program , and Additional Openings . Visa Sponsorship is not offered for this position. At Veradigm, our greatest strength comes from bringing together talented people with diverse perspectives to support the needs of healthcare providers, life science companies, health plans, and the patients they serve. The Veradigm Network is a dynamic, open community of solutions, external partners, and cutting-edge artificial intelligence technologies that provide advanced insights, technology, and data-driven solutions. Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings. Veradigm’s policy is to provide equal employment opportunity and affirmative action in all of its employment practices without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation or gender identity or expression or any other legally protected category. Applicants for North American based positions with Veradigm must be legally authorized to work in the United States or Canada. Verification of employment eligibility will be required as a condition of hire. Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce. From a VEVRAA Federal Contractor We request Priority Referral of Protected Veterans This is an official Veradigm Job posting. To avoid identity theft, please only consider applying to jobs posted on our official corporate site. Thank you for reviewing this Veradigm opportunity. Does this look like a great match for your skill set? If so, scroll on down and tell us more about yourself!

Requirements

Must-haves

Regulatory and Compliance Ownership
Partners with Legal, Privacy, Compliance, and Security on HIPAA, HITRUST, and SOC 2 obligations affecting protected health information in submission workflows, and on client-facing attestations and audit responses.
Product Strategy and Outcomes
Defines and owns accountability for business and customer outcomes across the VCS portfolio; establishes the success metrics and outcome frameworks that guide discovery and delivery, and reports honestly against them.
Defines multi-year strategy and roadmap for submissions, anchored in where regulation, payer economics, and interoperability are heading rather than in current feature parity.
Builds and maintains the competitive and buy-versus-build picture across risk adjustment and submissions vendors; makes explicit recommendations on where Veradigm should differentiate, partner, or exit.
Influences product strategy beyond direct scope, particularly where submissions intersect with risk adjustment analytics, care gap closure, provider data exchange, and Veradigm s clinical data assets.
Discovery and Customer Insight
Develops and maintains deep working knowledge of the customer, the data, the business, and the market; is recognized internally and externally as the domain expert for payer submissions.
Uses production and client data directly to find where submissions fail, where error volume concentrates, and where operational workarounds signal a product gap.
Delivery, Launch, and Execution
Champions and models the product trio with engineering and product design; drives shared decision making and coaches team leads on effective trio partnership.
Leads cross-functional product development and launch from concept to delivery for the portfolio s most complex initiatives; ensures alignment across engineering, QA, professional services, and technical operations.
Synthesizes and arbitrates requirements across clients, operations, compliance, and engineering for a multi-generational portfolio; resolves conflicts and drives alignment.
Plans releases against immovable regulatory deadlines; manages the trade-offs and cross-organizational dependencies that come with dates the company cannot negotiate.
Represents vision, strategy, roadmap, and regulatory risk to executive leadership with authority and clarity.
Commercial and Market Leadership
Defines and manages the product P&L within scope; sets program commitments, drives launch and go-to-market strategy with Marketing and Sales, and establishes performance baselines.
Develops and manages strategic partner and vendor relationships, including clearinghouses, data aggregators, and audit and coding partners; evaluates and negotiates business and contractual arrangements.

Nice-to-haves

Master s Degree, MBA, MPH, or MHA
Professional certification such as CRC (AAPC Certified Risk Adjustment Coder), CPC, CHC, or CPHQ
Experience shipping products used by health plan operations teams at scale, including workflow, exception handling, and audit trail design
Experience with high-volume data pipelines, cloud data platforms, or SaaS multi-tenant data processing
Experience applying automation or machine learning to coding, chart review, or data validation, including how to govern it in a regulated context

Application prep

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Keywords to mirror

gosqlmachine learning

Platform: workday
Effort: long

Benefits

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Dental

Vision

Professional Development