Payment Accuracy Manager, Outpatient Facility
Rialtic
full-time
Posted on:
Location Type: Remote
Location: United States
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About the role
- 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
Requirements
- 5-7 years of experience in payment integrity at a health plan, claims editing vendor, or similar healthcare organization with focus in outpatient facility claims editing and reimbursement methodologies
- Active coding certification (COC, 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
- Intermediate Excel skills (i.e., formulas, v-lookups, pivot tables, etc)
Benefits
- Health insurance
- Professional development opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
payment integrityclaims editingroot cause analysisdata-driven analysisfinancial impact assessmentExcelquantifying policy impactreimbursement methodologiescommon claims payment error identificationpolicy research
Soft Skills
analytical skillscommunicationclient advisingcollaborationproblem-solvingstrategic alignmentleadershippolicy developmentpresentation skillsquality assurance
Certifications
COCCPCCCS