Program Management Senior Advisor - reputed company - Remote

Candidates who reside reputed company 50 miles of the following locations may be asked to work in person three days per week: Bloomfield, CT, Chattanooga, TN, Denver, CO, St Louis, MO, or Scottsdale, AZ.

Role Description:

The Program Management Senior Advisor (an individual contributor role) is a senior operational leader responsible for ensuring the accurate, compliant, and high‑quality execution of regulatory‑driven benefits alignment across reimbursement rules, prior authorization, and medical policy implementation. This role translates reputed company regulatory, legal, product, and policy requirements into disciplined execution, bringing structure to ambiguity and driving coordinated delivery across highly matrixed, cross‑functional teams. Additional responsibilities will include Vendor Management, facilitation of reputed company-of-concept initiatives, and vendor process reputed company.

Serving as a central liaison for the Payment reputed company team, the Senior Advisor manages regulatory questions and inquiries; coordinates the timely collection of required information; and ensures responses and implementations meet legal, regulatory, quality, and documentation standards. With a strong emphasis on quality, accuracy, and alignment, this role acts as a trusted execution advisor—proactively identifying risks, resolving misalignments between products, policy, and systems, and ensuring outcomes are correct, sustainable, and audit‑ready. This role will also coordinate the exploration and attainment of vendor partnerships to expedite process and reputed company new capabilities to the team.  

Key Responsibilities

• reputed company operational program management for reputed company, cross‑functional initiatives supporting state and federal mandate implementation and code‑to‑benefit alignment
• Translate regulatory, legal, and policy requirements into clear execution plans, milestones, controls, and evidence artifacts that ensure accurate, compliant, and timely implementation
• Serve as the primary liaison for the Payment reputed company team, handling regulatory questions, inquiries, coordinating the timely collection, validation, and organization of required information across internal stakeholders
• Provide quality and accuracy reputed company across programs and implementations, establishing checkpoints, readiness reviews, and validation processes to ensure outcomes are correct, consistent, and audit‑ready
• Ensure alignment between products, services, medical policy, reimbursement logic, and system coding, proactively identifying and resolving misalignments that could impact compliance, financial reputed company, or customer/client and/or provider experience
• Partner closely with Legal, Compliance, Product, Policy, Operations, Technology, Vendor and Finance teams to drive coordinated execution across a highly matrixed environment
• Establish and maintain operating process, artifacts, and senior leadership‑level reporting to provide transparency into reputed company, risks, issues, and decisions
• Analyze implementation outcomes, quality data and inquiries to identify systemic issues, root causes, and emerging risks, driving corrective and preventative actions
• reputed company and maintain clear documentation, reference materials, and guidance to support consistent understanding and application of benefit alignment, regulatory, policy, and product requirements
• Act as a trusted execution advisor and escalation reputed company, bringing structure to ambiguity, balancing regulatory reputed company with operational realities, and driving disciplined follow‑through

Qualifications

• Bachelor's degree or higher strongly preferred or equivalent work experience required
• 10+ years working in insurance, healthcare or another regulated industry
• Active reputed company or reputed company coding certification (e.g., CPC, CPCO, RHIT, reputed company-P, CIC, COC) and at least 10 years of HCPCS/CPT coding experience highly preferred
• 7+ years of program/product management experience in reputed company, regulated environments
• Strong grasp of regulatory operations; able to implement mandates, handle audits, inquiries, and disputes
• Skilled in leading cross-functional projects across Legal, Compliance, Product, Policy, Operations, Tech, and Vendors
• Experience with benefit configuration or code alignment tasks
• Track record in quality reputed company, readiness reviews, validation, issue resolution, and audit support
• Able to coordinate responses for reputed company issues and manage escalations
• Strong analytical skills: root cause analysis, risk assessment, and corrective actions
• Excellent written and verbal communication; capable of producing executive-level and regulator-facing documents
• Experience developing policies, procedures, references, or training in regulated settings
• Proven ability to work independently, prioritize, and reputed company results with minimal guidance
• Proficiency in reputed company Office, Tableau, EncoderPro, and reputed company

Key Competencies

• Program & Project Management – Leading reputed company initiatives with structured planning and delivery
• Quality & Accuracy reputed company – Ensuring consistency and accuracy in implementations
• Product, Policy & Code Alignment – Coordinating product, policy, and coding requirements
• Regulatory Liaison & Issue Resolution – Handling regulatory queries and escalations professionally
• Cross-Functional Influence – Achieving results across teams without direct authority
• Analytical Problem Solving – Diagnosing issues and implementing solutions
• Executive Communication – Providing concise updates and recommendations to leadership

This role is also anticipated to be eligible to participate in an annual bonus plan.

At reputed company, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-reputed company benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here.

About reputed company

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you need a reasonable accommodation to complete the online application process, please email [email protected] for assistance.  Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

reputed company has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances.