Principal Product Manager, Veradigm Comprehensive Submissions

Veradigm®

. Own the most complex and strategically significant problems in the Veradigm Comprehensive Submissions portfolio .

Posted 10/1/2026full-timeRaleigh • North Carolina • United StatesLeadWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare payer data management, regulatory submissions, and product strategy development, with a strong focus on compliance and measurable outcomes. Proven ability to lead cross-functional teams and manage complex stakeholder requirements in a fast-paced environment.

Highest-signal resume keywords

Healthcare Payer Data ManagementRegulatory Submissions ExpertiseProduct Strategy DevelopmentCompliance Readiness ManagementStakeholder Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medicare Advantage Risk AdjustmentEncounter Data SubmissionX12 837I, 837P, 835, 277CA, 999, TA1, 834SQL ProficiencyICD-10-CM, CPT, HCPCS, LOINC, RxNorm, NDC KnowledgeQuality and Stars ReportingRADV Audit SupportCMS EDGE Server ExperienceMulti-Year Roadmap DevelopmentProduct Development Lifecycle Understanding

Soft Skills

Analytical Problem-SolvingStrong Verbal and Written CommunicationInterpersonal SkillsCollaboration in Matrixed EnvironmentsSound Judgment Under Regulatory Ambiguity

Tools & Technologies

HITRUSTSOC 2CMS-HCC V28HEDISNCQA Audits

Certifications & Qualifications

Master's DegreeMBAMPHMHACRCCPCCHCCPHQ

Industry Keywords

MedicaidCommercial ACAQuality ReportingRisk AdjustmentCompliance

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Own the most complex and strategically significant problems in the Veradigm Comprehensive Submissions portfolio
Serve as the authority on encounter and supplemental data submission requirements across Medicare Advantage, commercial ACA, Medicaid, and quality reporting
Monitor and interpret regulatory changes and convert them into prioritized, dated roadmap commitments
Own compliance readiness, including submission deadlines, sweeps calendars, validation, audit trails, record retention, and audit evidence
Partner with Legal, Privacy, Compliance, and Security on HIPAA, HITRUST, and SOC 2 obligations
Establish portfolio accuracy, completeness, timeliness, acceptance, rejection, error-resolution, and reconciliation measures
Define business and customer outcomes, success metrics, and outcome frameworks
Define multi-year product strategy and roadmap
Maintain competitive and buy-versus-build assessments and recommend differentiation, partnerships, or exit decisions
Lead continuous discovery with health plan risk adjustment, compliance, quality, and submissions operations leaders
Design research, prototypes, and data experiments to validate regulatory bets
Assess and mitigate value, usability, feasibility, and business viability risks
Use production and client data to identify submission failures, error concentrations, and product gaps
Champion the product trio with engineering and product design
Lead cross-functional product development and launch from concept through delivery
Author technical and functional specifications covering data mapping, transaction/file formats, validation logic, and error handling
Synthesize and arbitrate requirements across clients, operations, compliance, and engineering
Plan releases against immovable regulatory deadlines and manage dependencies and trade-offs
Represent vision, strategy, roadmap, and regulatory risk to executive leadership
Define and manage the product P&L within scope
Set program commitments and drive launch and go-to-market strategy with Marketing and Sales
Develop and manage strategic relationships with clearinghouses, data aggregators, audit partners, and coding partners
Lead client advisory boards and user groups
Represent Veradigm at RISE, AHIP, NCQA, and other industry forums
Coach and mentor product managers and senior product staff

Requirements

What you’ll need

Bachelor's Degree in a technical, business, health administration, or health informatics discipline, or equivalent work experience
10+ years of relevant experience in product management, technical program management, or solutions management
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
Demonstrated hands-on depth in the majority of the listed regulatory and submissions areas, with expert-level depth in at least two
Experience with Medicare Advantage risk adjustment and encounter data, including EDPS, RAPS, EDR, CRR, MAO-002, MAO-004, MOR, Monthly Membership Report reconciliation, CMS-HCC V28, and Part C/Part D reporting and sweeps
RADV audit support experience
Commercial ACA risk adjustment experience with CMS EDGE server and HHS-RADV audit cycles
Medicaid encounter submissions experience
Quality and Stars reporting experience, including HEDIS, ECDS, NCQA audits, and Medicare Star Ratings
Practical fluency with X12 837I, 837P, 835, 277CA, 999, TA1, and 834
Knowledge of ICD-10-CM, CPT, HCPCS, LOINC, RxNorm, and NDC code sets
Familiarity with HL7 v2, C-CDA, FHIR US Core/USCDI, TEFCA, and QHIN participation
Track record of delivering measurable business and customer outcomes
Experience defining enterprise product strategy and multi-year roadmaps
Experience leading advanced product discovery and establishing discovery practice
Experience managing products under hard external compliance deadlines
Executive stakeholder management and senior-level influence
Ability to read and independently interpret primary regulatory source material
Deep fluency in empowered product team practices, outcomes over output, continuous discovery, product trio, and four product risks
Ability to manage complex requirements across multiple stakeholders and product generations
Analytical and problem-solving skills, including working directly with SQL
Understanding of software product development lifecycle and end-to-end execution
Strong verbal and written communication skills
Sound judgment under regulatory ambiguity
Strong interpersonal and collaborative skills in matrixed environments
Ability to manage multiple priorities and deliver on time and on budget
Visa sponsorship is not offered
Applicants for North American-based positions must be legally authorized to work in the United States or Canada
Preferred: Master's Degree, MBA, MPH, or MHA
Preferred: CRC, CPC, CHC, or CPHQ certification
Up to 25% travel may be required; international travel may be required

Benefits

Comp & perks

Flexible work arrangements
Professional development opportunities
Holidays
Vacation
Medical insurance
Dental insurance
Vision insurance
Company-paid life insurance
Retirement savings
Equal employment opportunity and affirmative action workplace
Diverse and inclusive workforce