Rialtic

Manager

• Serve as the SME for outpatient facility editing policy development, leading the research, scoping, and creation of new claims editing policies for the facility capability
• Source, interpret, and scope new payment integrity policies to expand Rialtic's claims editing content library from outpatient facility claims
• 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 for facility claims
• Quantify and communicate policy value through data-driven analysis and clear financial impact assessments in the facility space
• Work closely with product and engineering teams to ensure client needs inform platform development, building out our facility capability
• Collaborate with content leadership to maintain consistency, quality, and relevance across the policy library
• Perform investigation of current facility policy defects and unexpected claim outcomes, performing root cause analysis and policy research to identify corrective actions and improve policy accuracy and performance
• Serve as the facility payment accuracy SME in client discussions, presenting policy concepts and addressing facility-related questions when needed

Payment Accuracy Manager, Outpatient Facility