Senior Manager, Content Performance & Coding Compliance
R
Rialtic, Inc.Healthcare SaaS
Atlanta or RemoteFull-TimeManager
Salary not disclosed
Apply NowOpens the employer's application page
Job Details
- Experience
- Minimum 5 years of experience in healthcare, preferably with at least 2-3 years in a leadership role in Payment Integrity, or Claims Operations
- Required Skills
- SlackNotion
Requirements
- Bachelor’s degree in healthcare administration, finance, or related field
- Minimum 5 years of experience in healthcare
- 2-3 years in a leadership role in Payment Integrity, or Claims Operations
- Strong understanding of commercial, Medicare, and Medicaid claims workflows
- Proficient in ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Level II coding
- Knowledge of CMS, Medicaid, and ACA guidelines
- Ability to interpret large datasets
- 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 limited predefined process
- Strong written and verbal communication skills
- Experience with modern asynchronous communication tools such as Slack, Zoom, Notion and Google Drive
- Experience with commercial, Medicare Advantage, and/or Medicaid plans (preferred)
- Certified Professional Coder (CPC) or similar credential (preferred)
Responsibilities
- 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
- Research potential policy defects and resolve inquiries submitted by clients and colleagues
- Troubleshoot policy defects and collaborate with Content and Engineering teams to adjust and resolve policy design
- Lead root cause analysis (RCA) of identified policy defects to determine additional controls needed
- Proactively leverage policy utilization trend data to monitor, investigate, and mitigate insight rate anomalies
- Leverage data to identify and develop process changes, automation/tooling enhancements, and scalable, AI-enabled approaches
- Partner with Product and Engineering teams to define and drive strategic Content platform enhancements
- Lead the ongoing maintenance of Rialtic’s policy library to ensure policies remain accurate and up-to-date
- 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
View Full Description & ApplyYou'll be redirected to the employer's site
