Payment Accuracy Policy Manager jobs in United States
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Rialtic · 1 week ago

Payment Accuracy Policy Manager

positionUnited States
timeFull-time
remoteRemote
senioritySenior Level
date5+ years exp

Rialtic is a company focused on healthcare payment expertise and product innovation. They are seeking a Payment Accuracy Policy Manager to develop and implement payment integrity policies that enhance their platform capabilities while protecting clients. The role involves collaborating with various teams to translate complex payment policies into actionable strategies that deliver measurable value.

Enterprise SoftwareHealth CarePayments

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

Qualification

Payment integrity expertiseActive coding certificationCMS reimbursement guidelinesAnalytical skillsClaims editing implementationGoogle Suite proficiencyCommunication skills

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

Company

Rialtic

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Rialtic operates an open marketplace enterprise platform designed to equip and assist payers to make accurate healthcare payments.
dateFounded in 2020
location
Atlanta, Georgia, USA
people-size51-200 employees
web-link
https://rialtic.io

Funding

Current Stage
Growth Stage
Total Funding
$79.71M
Key Investors
F-PrimeOak HC/FT
2023-08-04Series Unknown· $36.71M
2022-03-02Series A· $28M
2020-10-22Series A· $15M

Leadership Team

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J. Douglas Williams
Founder
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Roy Ziegler
Advisory Board
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Company data provided by crunchbase