The posting
Product Owner - Revenue Cycle Management (Claims and Full RCM)
About the role :
Adit is building a native revenue cycle platform inside the dental PMS. Insurance Verification is live and profitable; claims, attachments, ERA posting, and denial management are being built out on top of it. The strategy, pricing architecture, and partner structure are set by the VP of Product. This role owns making it real. You are accountable for the backlog, the specs, the release, and the rollout — for turning an EDI-heavy, partner-dependent roadmap into working software that clears payer edits, posts cash correctly, and holds up in production at scale.
This is an execution mandate. Success is measured in shipped, stable, adopted releases — not in decks.
Core mandate :
Own the backlog
- Maintain a single, prioritized, groomed claims backlog — epics, stories, spikes, and defects in one ranked order
- Write acceptance criteria precise enough for engineering to build and QA to test without a follow-up meeting
- Run grooming, sprint planning, daily standups, reviews, and retros; keep sprints scoped and predictable
- Make the tactical trade-off calls in-sprint — scope cuts, sequencing, "ship now vs. fix now" — and escalate only what genuinely needs the VP
Own the specification detail
- Translate roadmap intent into EDI-level specs: 837D claim construction, 277CA rejection handling, 835 posting and adjustment logic, 270/271 eligibility reuse, attachment payloads and payer requirements
- Document payer-specific edits, frequency limitations, downgrade and COB rules as testable business rules — not prose
- Own the exception taxonomy: what fails, where it queues, who touches it, and what the resolution path is
- Keep specs current as payer and clearinghouse behavior changes in the field
Own release readiness and rollout
- Define release scope, entry/exit criteria, and go/no-go signals
- Build and execute test plans with QA, including EDI validation, payer sandbox testing, and end-to-end claim-to-cash regression
- Run design-partner pilots: recruit practices, define success criteria, sit in on live usage, close the loop on findings
- Own phased rollout, feature flags, migration plans, and rollback conditions
- Write release notes, training material, and enablement content for Implementation, Support, and Sales
Own production quality
- Triage incoming defects and escalations daily; own severity calls and turnaround commitments
- Monitor the operational dashboards — rejection rates, posting failures, queue depth, SLA breaches — and act before customers report
- Run root-cause reviews on production incidents and drive the fix into the backlog
- Be the escalation point of record for claims issues across Support and Operations
- Own the operational handoff
- Work with offshore RCM operations to define what the software automates and what a human still touches
- Instrument touch rate per claim and drive it down release over release
- Build the tooling, queues, and audit trails the ops team needs to work efficiently
Partner interface (execution level)
- Day-to-day technical coordination with clearinghouse partners: integration scope, testing cycles, enrollment flows, ticket escalation, certification milestones
- Feed real utilization and cost data (claims per location, attachment attach rate, per-transaction spend) back to the VP for pricing and contract decisions
- Commercial terms and partner selection sit with the VP of Product; you own delivery against them.
What we're looking for :
Required
- 4–8 years as a Product Owner, Business Analyst, or delivery-focused PM on healthcare RCM, claims, clearinghouse, or medical/dental billing products
- Working fluency in X12 EDI — 837, 835, 270/271, 277CA. You can read a rejection code, trace it to the loop and segment, and write the story to fix it
- Understanding of payer adjudication mechanics: plan design, frequency limitations, downgrades, coordination of benefits, bundling
- Demonstrated ownership of a backlog in an Agile/Scrum environment; comfortable running ceremonies and holding a team to a sprint commitment
- Exceptional written precision — acceptance criteria, business rules, and edge cases are your primary output
- SQL or equivalent data fluency; you pull your own numbers to triage a defect or size an issue
- Composure under production pressure; you can run an escalation without escalating
Strongly preferred
- Dental-specific background: CDT coding, dental attachments (NEA/FastAttach or payer-direct), dental payer quirks
- Hands-on experience integrating with a clearinghouse (Vyne, DentalXChange, Change/Optum, Availity, Stedi) including enrollment and certification cycles
- Experience working with offshore operations teams as part of the delivery model
- Exposure to AI/ML-assisted workflows — claim scrubbing, denial prediction, or auto-remediation
- CSPO/CSM or equivalent; experience with Jira/Asana-based delivery at scale
What success looks like :
- By 60 days — You own the claims backlog end to end, ceremonies run on cadence, and specs for the next two releases are written to a standard engineering can build from without clarification loops.
- By 6 months — Claims and attachments are in production with design partners on a predictable release cadence; rejection turnaround, posting accuracy, and defect-aging baselines are instrumented and improving.
- By 12 months — Releases ship on schedule with no critical post-release regressions, manual touch per claim is materially down, and Implementation and Support can onboard and troubleshoot claims without pulling you in by default.
How we'll evaluate you
- Sprint predictability and release quality
- Defect escape rate and time-to-resolution on production escalations
- Straight-through processing rate and manual touch per claim
- Design-partner adoption and time-to-first-successful-claim for new practices
- Spec quality, measured by how few clarification cycles engineering and QA need
Why this role
- A clear, funded roadmap and an existing revenue base — you execute against direction, not ambiguity
- Real ownership of the delivery machine: backlog, release, quality, and rollout are all yours
- Deep domain work in a space where getting the details right is the entire product
