Payment Accuracy - Content Policy Manager
Please note: This role requires EST hours and is open to East Coast candidates only.
Overview
As a Payment Accuracy Policy Manager, you will serve as a critical bridge between healthcare payment expertise, client strategy, and product innovation. This role combines deep subject matter knowledge with strategic influence—driving the development of payment integrity policies that protect our clients while advancing Rialtic's platform capabilities.
You'll lead the research, evaluation, and implementation of new policies based on CMS guidelines, Medicaid requirements, industry standards, and emerging medical cost trends. Working closely with client management, product, engineering, and content leadership teams, you'll translate complex payment policy concepts into actionable strategies that deliver measurable value. This is an opportunity to shape how health plans approach payment integrity while building the content foundation that powers our enterprise platform.
Responsibilities
- Source, interpret, and scope new payment integrity policies to expand Rialtic's claims editing content library
- Prioritize policy updates based on savings potential, client impact, and strategic alignment with platform goals
- Leverage CMS, Medicaid, clinical guidelines, and industry trends to identify opportunities for new content development
- Quantify and communicate policy value through data-driven analysis and clear financial impact assessments
- Identify adoption gaps, implementation inefficiencies, and emerging opportunities within client programs
- Work closely with product and engineering teams to ensure client needs inform platform development
- Collaborate with content leadership to maintain consistency, quality, and relevance across the policy library
- Serve as the payment integrity expert across enterprise initiatives, providing consultative guidance to internal teams
Qualifications
Required
- 5-7 years of experience in payment integrity at a health plan, claims editing vendor, or similar healthcare organization
- Active coding certification (CPC, CCS, or equivalent specialty certification) — required for this position
- Proven expertise in:
- Interpreting medical and payment policies
- Applying CMS and Medicaid reimbursement guidelines
- Professional and outpatient coding standards
- Common claims payment error identification and resolution
- Demonstrated ability to advise clients and explain complex payment accuracy concepts in clear, accessible terms
- Strong analytical skills with experience quantifying policy impact and ROI
- Track record of managing claims editing implementations or similar client-facing initiatives
Preferred
- Expertise across both professional and institutional claims environments
- Advanced proficiency with Google Suite or similar collaboration tools
- Experience working cross-functionally with product and engineering teams in a SaaS or health tech environment
- Exceptional written and verbal communication skills with the ability to influence stakeholders at all levels
