MedRisk is a strategic leader in the healthcare industry, and they are seeking a Network Product Manager to define and evolve their Medical Bill Processing and PPO Repricing products. This role involves overseeing product strategy, network evaluation, and cross-functional leadership to enhance network effectiveness and client outcomes.
Responsibilities:
- Define and execute the long-term product strategy for Medical Bill Review, repricing, and PPO network solutions
- Establish MedRisk as a thought leader and innovator in medical cost containment and network optimization
- Develop and articulate a clear value proposition for national, regional, and specialty network offerings
- Continuously assess market trends, regulatory developments, and competitive dynamics to evolve product strategy
- Own the end-to-end process for evaluating PPO networks and sub-networks, including national, regional, and specialty offerings
- Develop and maintain a formal network evaluation framework that assesses:
- Provider access and geographic coverage
- Repricing performance and savings consistency
- Provider contract quality and fee schedules
- Data transparency, reporting, and operational integration
- Compliance, defensibility, and audit support
- Identify the optimal mix of networks and sub-networks to maximize savings, access, and client outcomes
- Lead network partner selection, rationalization, and ongoing performance reviews, including recommendations to add, sunset, or replace networks
- Partner with Legal and Compliance to evaluate contractual terms, regulatory risk, and network defensibility
- Design and oversee a tiered network strategy that balances:
- National PPO coverage
- Regional market strength
- Specialty network depth
- Identify coverage or performance gaps and define strategies to strengthen network reach and effectiveness
- Ensure network configurations are optimized for client needs, jurisdictional requirements, and specialty use cases
- Ensure network and sub-network selections directly support medical bill review workflows, repricing accuracy, and cost containment goals
- Collaborate with Operations and Clinical teams to ensure network design supports accurate repricing, defensibility, and dispute resolution
- Drive improvements that enhance repricing yield, turnaround time, and savings predictability
- Work closely with Sales and Client Management to support go-to-market strategy, pricing models, and client-facing network positioning
- Translate network evaluation outcomes into clear internal guidance and external messaging
- Partner with Technology and Data teams to define requirements for network performance analytics, benchmarking, and reporting tools
- Collaborate with Legal and Compliance to ensure network strategies meet all regulatory and contractual standards
- Define and monitor KPIs related to network and sub-network performance, including:
- Repricing savings and hit rates
- Network access and penetration
- Provider participation and overlap
- Client satisfaction and retention
- Use performance insights to drive continuous optimization of network partnerships and product strategy
Requirements:
- Bachelor's degree required
- 7–10+ years of experience in healthcare product management, PPO networks, medical bill review, or cost containment
- Demonstrated experience evaluating, selecting, and managing PPO networks and sub-networks
- Strong understanding of PPO network contracting and fee structures
- Strong understanding of medical billing and reimbursement methodologies
- MBA or advanced degree
- Workers' compensation and/or complex reimbursement environments