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Payment Accuracy Policy Manager

ManagerManagerFull TimeRemoteTeam 51-200H1B SponsorCompany Site LinkedIn

Location

United States

Posted

64 days ago

Salary

Not specified

Professional Certificate5 yrs expEnglish

Job Description

• 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

Job 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)