Interoperability Product Owner

About this role

Job Summary:

The Interoperability Product Owner is responsible for ensuring compliance with interoperability mandates and legal requirements, with a focus on the CMS-0057-F mandate and its expanding scope for payers. They will work closely with compliance teams, vendors, and external guidance/counsel to uphold CareSource's standards and commitment to excellence. This role serves as the single point of contact bridging compliance and business teams, translating CMS implementation guides and regulatory requirements into actionable requirements for clinical operations, membership operations, IT, Digital, and Customer Experience teams. Additionally, this role is responsible for ensuring CareSource meets HIPAA Transaction Code Set compliance for EDI and overseeing any current or future audits in this space and act as the main point of contact to translate and drive direction for the participating and implementation of TEFCA requirements and frameworks.

Essential Functions:

• Lead the oversight for any current or future compliance related audits and initiatives related to interoperability, active CMS audits (HIPAA Transaction Code Set compliance), ensuring CareSource meets all necessary compliance requirements.
• Actively participate in the Trusted Exchange Framework and Common Agreement (TEFCA) framework, anticipating proposed changes and their implications for data retrieval and sharing, and identifying opportunities to leverage TEFCA for payment processing, case coordination, and quality risk assessment.
• Collaborate with internal teams to establish data sharing agreements, ingestion contracts, and capabilities that meet compliance and operational needs.
• Serve as a single point of contact between the compliance and business teams to translate and align interoperability needs — drawn from CMS implementation guides, CMS-0057-F, and other regulatory sources — into actionable requirements.
• Educate internal teams on compliance impacts and operational changes...