• Interpret and translate complex CMS, AMA/CPT, and commercial payer policies into actionable claims editing logic that drives measurable payment accuracy • Leverage data-driven insights to identify and make recommendations for new policy opportunities • Own the development of precise, high-quality edit specifications in close partnership with Engineering to ensure seamless implementation. • Act as a subject matter expert across Medicaid, Medicare, and commercial lines—providing deep expertise in coding, billing, and reimbursement. • Maintain and enhance existing content by proactively monitoring and applying regulatory and policy updates for the Policy and Content Management team on our payment integrity teams. • Ideate and scope policy for our clients. • Analyze performance data to confirm the efficacy of edits, and clearly document the rationale and results to support both internal and external stakeholders. • Collaborate cross-functionally with Product and Engineering to improve tooling, streamline development workflows, and enhance overall content delivery. • Independently manage the end-to-end lifecycle of content edits—from research and ideation through deployment and post-release validation. • Stay current on evolving healthcare regulations and coding guidelines to ensure Rialtic’s logic remains comprehensive and compliant. • Consistently exceed productivity and quality targets while thriving in a remote, outcomes-driven environment.