Network Product Manager

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