Carex is partnering with a growing Healthtech partner to hire a net-new Senior Product Manager – RCM to lead the development and commercialization of AI-powered solutions that improve healthcare revenue cycle performance. This role will own the product lifecycle from initial use case discovery and validation through prototyping, pilot execution, launch, and customer adoption. The ideal candidate combines deep, hands-on healthcare revenue cycle experience with a proven track record in software product management. This individual must understand the operational complexities of clinical denials, appeals, clinical documentation improvement (CDI), utilization review, hospital billing, and payment integrity, with the ability to translate real-world challenges into scalable, measurable technology solutions.
This is a highly strategic, hands-on role requiring strong technical aptitude, an entrepreneurial mindset, and an AI-first approach to product development. The Senior Product Manager will work closely with health system leaders, revenue cycle professionals, engineers, AI teams, and commercial stakeholders to identify high-value opportunities, build working prototypes, and deliver solutions that demonstrate measurable financial impact.
What You’ll Do
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Own the end-to-end product strategy, roadmap, and execution for AI-driven revenue intelligence solutions, from initial discovery through commercialization and customer adoption.
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Evaluate opportunities across clinical denials, prior authorization, payment integrity, CDI, and coding to identify the strongest initial market entry point based on customer needs, financial impact, competitive differentiation, and commercial viability.
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Conduct discovery with health system CFOs, revenue cycle executives, revenue integrity leaders, HIM directors, CDI specialists, coders, utilization review teams, and physician advisors to uncover operational challenges and validate product opportunities.
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Incorporate payer perspectives into product strategy, including payment integrity, clinical claim review, adjudication, medical necessity, utilization management, and prior authorization.
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Map end-to-end revenue cycle workflows across Epic and other major EHR platforms, including Oracle Health and MEDITECH, identifying critical decision points, operational bottlenecks, exceptions, and handoffs.
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Translate complex clinical, financial, and operational workflows into detailed product requirements, user stories, acceptance criteria, test cases, and intuitive user experiences.
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Define product data requirements across clinical documentation, claims, remittances, denial codes, payer policies, medical necessity criteria, and other relevant healthcare datasets.
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Partner closely with engineering, data science, and AI teams to design, prototype, test, and deliver scalable solutions that integrate into existing healthcare technology environments.
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Build functional prototypes independently using AI-assisted development tools such as Claude Code, Cursor, or similar platforms to validate concepts before committing engineering resources.
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Establish evaluation frameworks for AI-enabled features, including golden datasets, accuracy measurements, hallucination detection, safety controls, and appropriate human-in-the-loop validation.
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Develop evidence-based business cases that quantify opportunities through denial volumes, overturn rates, appeal costs, avoidable write-offs, reimbursement recovery, and time-to-resolution improvements.
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Define measurable product success criteria, establish baseline performance metrics, and use SQL and analytical tools to evaluate outcomes and inform product decisions.
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Lead design-partner engagements and pilot programs with health systems, validating product performance using real-world, de-identified cases and measuring results against established financial and operational benchmarks.
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Collaborate with Sales and commercial leadership to develop pricing, packaging, competitive positioning, demonstrations, pilot proposals, and ROI models that support enterprise purchasing decisions.
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Analyze competitive solutions across revenue cycle management vendors, outsourcing providers, autonomous coding platforms, EHR-native capabilities, and internally developed technologies.
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Navigate complex health system buying processes, including executive sponsorship, finance reviews, IT security assessments, procurement, and governance approvals.
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Develop clear, evidence-backed product recommendations, including market opportunity assessments, customer insights, technical feasibility, competitive analysis, and go/no-go criteria.
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Establish feedback loops between denial outcomes, clinical documentation, and revenue cycle operations to reduce recurring errors and improve financial performance.
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Present product strategy, pilot outcomes, financial impact, and roadmap recommendations to executive leadership and customer stakeholders.
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Drive initial product validation within the first 60 days and progress from prototype to a design-partner pilot and commercially viable offering within the first 12 months.
What You’ll Bring
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8+ years of healthcare revenue cycle experience, including direct, hands-on experience within hospital or health system operations and at least 3 years of product management or product ownership experience with revenue cycle management software.
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Demonstrated practitioner-level experience in at least one of the following areas: inpatient clinical denials and appeals, DRG clinical validation, CDI, utilization review, medical necessity, prior authorization, or payment integrity.
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Deep understanding of hospital revenue cycle operations, including facility and professional billing, clinical documentation, reimbursement methodologies, denial management, and revenue integrity.
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Hands-on experience with Epic revenue cycle workflows, particularly Resolute Hospital Billing, or comparable platforms such as Oracle Health or MEDITECH. Epic experience is strongly preferred.
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Working knowledge of UB-04 forms, 837I claims, 835 remittances, DRGs, CARC and RARC codes, payer contracts, and related reimbursement processes.
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Proven experience developing and launching healthcare software products, including translating operational requirements into technical specifications and managing delivery from prototype through production.
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Strong analytical capabilities, including proficiency with SQL, financial modeling, KPI development, and performance measurement.
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Ability to quantify revenue cycle challenges, establish credible financial baselines, and present defensible ROI calculations to health system CFOs and executive stakeholders.
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Technical fluency sufficient to participate in architecture discussions, collaborate with engineers on debugging, evaluate integration requirements, and make informed product tradeoffs.
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Demonstrated daily use of AI tools for research, analysis, synthesis, prototyping, and product development.
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Hands-on experience independently building functional prototypes using AI-assisted coding tools such as Claude Code, Cursor, or equivalent technologies.
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Understanding of AI evaluation methodologies, including golden datasets, model reliability, hallucination detection, clinical and financial safety considerations, and domain expert validation.
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Experience designing AI-enabled workflows that incorporate appropriate human oversight, particularly for high-stakes clinical and financial decisions.
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Strong product discovery skills, including customer interviewing, hypothesis testing, workflow analysis, market validation, and evidence-based prioritization.
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Experience developing detailed requirements, acceptance criteria, test cases, and technical documentation that support effective collaboration across product, engineering, and AI teams.
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Strong communication and presentation skills, with the ability to translate complex revenue cycle and technical concepts for both engineering teams and senior healthcare executives.
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Experience working effectively with distributed, cross-functional, and global teams.
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Entrepreneurial, self-directed approach with the ability to operate independently, make difficult prioritization decisions, and deliver measurable outcomes in ambiguous, fast-moving environments.
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Strong product design intuition and the ability to simplify complex healthcare workflows into intuitive, practical solutions.
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Customer-focused mindset with a demonstrated commitment to owning product performance and outcomes beyond initial launch.
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Payer-side experience in payment integrity, clinical claim review, adjudication, or utilization management within a national or provider-sponsored health plan is a strong plus.
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Familiarity with Medicare Advantage denials, inpatient status determinations, two-midnight rules, and level-of-care downgrades is preferred.
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Established relationships with health system revenue cycle leaders and experience navigating enterprise healthcare purchasing decisions are advantageous.
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Experience launching AI-powered or analytics-driven products into health systems, including design-partner pilots, procurement reviews, and commercial adoption, is preferred.
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Working knowledge of HL7, FHIR, healthcare interoperability standards, and enterprise integration patterns is a plus.
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Familiarity with cloud infrastructure, particularly Microsoft Azure or AWS, is beneficial.
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Understanding of HIPAA, business associate agreements (BAAs), hospital IT security requirements, and healthcare technology governance processes is preferred.
Carex Consulting Group is an equal opportunity employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, marital status, disability, gender identity or Veteran status.
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