Medicare Manager Jobs in Virginia (NOW HIRING)

Senior Product Manager-Medicare ClaimsSystemsSME

TRIAprides itself in leading the charge for innovation and transformation in the federal government space. We offertechnologicalimplementations and build customer-centric services that are simple, intuitive, and usable across multiple industries. By partnering with federal agencies, our specialized digital services are reimagining and reshaping the digital landscape to bring positive change for millions of Americans.

At Tria, we are a dynamic professional community driven by a mission rooted in service to colleagues, customers, andthecommunity. Tria invests in its employees with a top-tier benefits package to support their physical, mental, and financialwell-being.

Job Description:

Tria is seeking a Senior Product ManagerandMedicare Claims Systems SMEto support the Centers for Medicare & Medicaid Services (CMS) system thatmaintainsMedicare beneficiary entitlement andutilizationdata andvalidatesfee-for-service claims. The Senior Product Manager translates CMS business and regulatory requirements into clear product requirements and user stories, manages the product backlog with the Product Owner and CMS stakeholders, and guides an Agile team to deliver Change Requests and problem fixes within CMS's established release calendar. This role sits on a collaborative, Agile teammaintaininga mission-critical Medicare claims processing system.

This is aremote position,and all remote work must be performed in the United States.

Basic Requirements

• Ability to obtain a U.S. Federal Position of Trust clearance.

• Mustresidein and perform work in the United Statesand must have lived in the United States for three of the last five years.

• Bachelor's degree.

• 10+ years of combined experience across healthcare IT, Medicare or Medicaid programs, or CMS regulatory compliance.

• 5+ years as a product owner, product manager, or business analyst in Agile software delivery, working with sprint teams and tools such as Jira and Confluence to capture requirements and develop business process models.

• 3+ years with direct experience in Medicare or Medicaid claims processing or CMS shared systems.

Additional Qualifications

• Certified in a product owner or product manager Agile credential (for exampleSAFePOPM, CSPO, or PSPO) and experienceoperatingwithin the Scaled Agile Framework (SAFe), including PI Planning.

• Experience translating complex federal regulations and CMS business requirements into user stories with clear acceptance criteria.

• Ability to analyze business processes, evaluate system and downstream impacts,identifygaps, and recommend improvements.

• Strong oral and written communication, with the ability to document complex problems simply and clearly.

• Experience developing Change Requests and working within change control processes.

• Experience interpreting CMS guidance and HPMS memoranda and translating complex Medicare regulations into operational requirements, policies, and procedures.

• Familiarity with CMS shared systems and Medicare claims processing environments, including mainframe-based systems, is a plus.

Responsibilities

• Maintain the product backlog with the Product Owner, the COR, and end users, capturing CMS requirements as user stories with robust acceptance criteria.

• Maintain and enhance the product roadmap and collaborate with CMS on prioritization and capacity planning.

• Work with the Agile team through backlog refinement, sprint planning, and PI Planning to align development and testing with CMS business needs and the release calendar.

• Become an expert in CMS regulations, policies, and the CWF system, and conduct policy and program analysis to develop and adapt business requirements.

• Evaluate system and downstream impacts of Change Requests, provide high-level business requirements, and support estimation.

• Work with the sprint team to implement and accept user stories,validatecompleted work against the definition of done, and support release readiness.

• Develop Change Requests andsupportingAgile documentation and oversee related quality assurance activities.

• Proactively surface risks, dependencies, and competing priorities, coordinating with stakeholders to support quality andtimelydelivery.

Public Trust Clearance:

Many of our roles require the hired candidate to go through public trust clearance. A minimum of 3 years of stay in the U.S. within the last 5 yearsis required tobe eligible to qualify for public trust clearance sponsorship.

Work Location:

Headquarteredin Arlington, VA, we also have a primary office in Baltimore, MD for those who prefer to work on-site.Thie role requires the employee to be available to go to our Woodlawn MD office twice a week.However, with employees spread across 40+ states, we have many remote roles.