Senior Manager, Content Performance – Coding Compliance

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🕒 May 14

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

✍️ Content Marketing Manager

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Rialtic

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

☁️ SaaS

💳 Fintech

Healthcare Insurance • SaaS • Fintech

Rialtic is a next-generation healthcare technology company focused on making healthcare more efficient. The company offers a cloud-based SaaS platform designed to improve payment accuracy within the healthcare system. Rialtic's platform enables healthcare payers and providers to save on administrative expenses and medical costs through transparent and comprehensive edits, enhancing provider collaboration with self-service configurations and reporting. By streamlining on-premise solutions into a single user-friendly platform, Rialtic helps organizations manage workflows, minimize redundancies, and promote cross-team collaboration. The platform provides powerful analytics, allowing users to monitor performance and identify new savings opportunities, thus driving healthcare innovation through technology.

📋 Description

• Grow and lead a high-performing team of Content Policy Managers and Analysts • Serve as a player-coach, creating an environment of ownership, resilience, and high accountability — without micromanaging • Research potential policy defects and resolve inquiries submitted by clients and colleagues from across the enterprise • Troubleshoot policy defects and collaborate with Content and Engineering teams to adjust and resolve policy design to deliver the intended functionality • Lead root cause analysis (RCA) of identified policy defects to determine additional controls needed to drive E2E continuous quality improvement • Proactively leverage policy utilization trend data to monitor, investigate, and mitigate insight rate anomalies • Leverage the combined policy defect and utilization trend data to identify and develop process changes, automation/tooling enhancements, and scalable, AI-enabled approaches to drive increased efficiency and quality across the E2E Content development process • Partner with Product and Engineering teams to define and drive strategic Content platform enhancements • Maintain a strong sense of speed of play — balancing urgency with quality • Lead the ongoing maintenance of Rialtic’s policy library to ensure policies remain accurate and up-to-date with source changes • Lead the implementation of new CPT, HCPCS, and ICD-10 codes across Rialtic’s policy library • Manage Rialtic’s subscriptions to Content reference sources and serve as vendor relationship manager

🎯 Requirements

• Bachelor’s degree in healthcare administration, finance, or related field; Master’s degree or MBA preferred. • Minimum 5 years of experience in healthcare, preferably with at least 2-3 years in a leadership role in Payment Integrity, or Claims Operations • Experience with both payer and provider perspectives is strongly preferred. • Strong understanding of commercial, Medicare, and Medicaid claims workflows, including pre- and post-pay integrity processes. • Proficient in ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Level II coding and their use in policy and reimbursement logic. • Knowledge of CMS, Medicaid, and ACA guidelines and how they inform content strategy and compliance. • Ability to interpret large datasets; experience collaborating with data science teams on fraud, waste, and abuse detection or pattern recognition. • Skilled in building scalable processes, identifying automation solutions, and delivering continuous quality improvements. • Understanding of how clinical content is deployed and managed within rule engines and claims editing platforms. • Experience leading small teams, mentoring talent, and delivering outcomes in high-change environments. • Comfortable operating in dynamic settings with evolving priorities and a limited predefined process. • Strong written and verbal communication skills for cross-functional collaboration and stakeholder alignment. • Comfort with modern asynchronous communication tools such as Slack, Zoom, and other documentation solutions such as Notion and Google Drive.

🏖️ Benefits

• Freedom to work from wherever you work best and a home office stipend to make it happen • Meaningful equity and 401 (k) matching • Unlimited PTO, comprehensive health plans, and wellness reimbursements • Comprehensive health plans with generous contributions to premiums • Mental and physical wellness support through TalkSpace, Teladoc, and One Medical subscriptions