Payment Accuracy Policy Manager
Rialtic
full-time
Posted on:
Location Type: Remote
Location: United States
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About the role
- 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
Requirements
- 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
- Expertise across both professional and institutional claims environments (preferred)
- Advanced proficiency with Google Suite or similar collaboration tools (preferred)
- Experience working cross-functionally with product and engineering teams in a SaaS or health tech environment (preferred)
- Exceptional written and verbal communication skills with the ability to influence stakeholders at all levels (preferred)
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
payment integrityclaims editingmedical policies interpretationCMS guidelinesMedicaid reimbursementcoding standardsclaims payment error resolutionpolicy impact quantificationROI analysisclaims editing implementation
Soft skills
analytical skillsclient advisingcommunication skillsinfluencing stakeholderscollaborationconsultative guidanceproblem-solvingstrategic alignmentquality maintenancecross-functional teamwork
Certifications
CPCCCS