Rialtic, Inc.

Payment Accuracy Manager, Outpatient Facility Overview As a Payment Accuracy Policy Manager, you will serve as a critical bridge between healthcare payment expertise in our facility capability. This role combines deep subject matter knowledge with strategic influence—driving the development of payment integrity policies that protect our clients while advancing Rialtic's platform capabilities. You'll lead the research, evaluation, and implementation of new policies based on CMS guidelines, Medicaid requirements, industry standards, and emerging medical cost trends in the facility space of our offering. Working closely with client management, product, engineering, and content leadership teams, you'll translate complex payment policy concepts into actionable strategies that deliver measurable value. This is an opportunity to shape how health plans approach payment integrity and to build the content foundation that powers our enterprise platform. Responsibilities - Serve as the SME for outpatient facility editing policy development, leading the research, scoping, and creation of new claims editing policies for the facility capability - Source, interpret, and scope new payment integrity policies to expand Rialtic's claims editing content library from outpatient facility claims - 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 for facility claims - Quantify and communicate policy value through data-driven analysis and clear financial impact assessments in the facility space - Work closely with product and engineering teams to ensure client needs inform platform development, building out our facility capability - Collaborate with content leadership to maintain consistency, quality, and relevance across the policy library - Perform investigation of current facility policy defects and unexpected claim outcomes, performing root cause analysis and policy research to identify corrective actions and improve policy accuracy and performance - Serve as the facility payment accuracy SME in client discussions, presenting policy concepts and addressing facility-related questions when needed Qualifications Required - 5-7 years of experience in payment integrity at a health plan, claims editing vendor, or similar healthcare organization with focus in outpatient facility claims editing and reimbursement methodologies - Active coding certification (COC, 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 - Intermediate Excel skills (i.e., formulas, v-lookups, pivot tables, etc) 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

Role Overview The Senior Manager, Claims Analytics, leads the claims analytics function within the Implementation organization. This role is responsible for overseeing complex reimbursement and payment accuracy analyses, managing analysts, setting analytical standards, and partnering cross-functionally with GTM, Customer Success, Product, and Engineering teams to ensure successful client implementations. This role combines deep healthcare claims expertise with people leadership, strategic thinking, and operational execution to scale analytics capabilities and drive measurable financial outcomes for clients. Key Responsibilities Leadership & Strategy - Lead and mentor a team of Implementation Claims Analysts, setting priorities, performance expectations, and development plans. Define and standardize analytical methodologies, reporting frameworks, and best practices for claims and reimbursement analysis. - Partner with Implementation leadership to align analytics deliverables with client goals, timelines, and success metrics. - Act as a subject-matter expert in claims analytics for complex or high-visibility client implementations. Analytics & Execution - Oversee large-scale analysis of claims data related to charge capture, reimbursement, underpayment, overpayment, and payment accuracy. - Ensure the delivery of exception-driven, actionable insights that clearly identify systemic versus isolated issues. - Review and validate analytical outputs, ensuring accuracy, consistency, and clarity in reporting and client-facing deliverables. - Guide analyses related to: - Payor reimbursement behavior and trends - RVU productivity and payment alignment - Revenue cycle optimization opportunities - Financial performance to benchmarks, goals, and norms Cross-Functional Collaboration - Partner with GTM and Customer Success teams to support implementations, renewals, and expansion opportunities through analytics insights. - Collaborate with Product and Engineering teams to influence roadmap priorities based on claims analysis findings and client needs. - Serve as a senior analytics representative in client-facing discussions, executive readouts, and strategic reviews. Technical Oversight - Guide data ingestion and processing pipelines using SQL*Loader, Oracle, shell scripting, and cloud-based tools. - Oversee advanced analytics leveraging SQL, PL/SQL, Python, Scala, Spark, and AWS. - Ensure scalable, repeatable approaches to analyzing billions of claims records across clients. Required Qualifications - 8+ years of experience in healthcare claims analytics, payment accuracy, or reimbursement analysis. - Prior experience working with claims editing or payment accuracy vendors. - Strong expertise in medical coding, billing guidelines, and reimbursement methodologies. - Proven people leadership experience managing and developing analytics teams. - Advanced proficiency in SQL and experience working with large healthcare datasets. - Strong executive communication and presentation skills.\

As a Research Consultant, you’ll transform complex healthcare policy into intelligent, automated logic that powers Rialtic’s payment accuracy engine. Working at the intersection of clinical expertise, policy research, and SaaS development, you’ll create high-impact claims editing rules that help leading payers reduce overpayments and promote transparent, accurate reimbursement practices. This is a high-autonomy, high-impact role for someone who thrives in a collaborative, cross-functional environment and is eager to deepen their technical expertise while shaping a modern healthcare platform. 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 Act as a subject matter expert across Medicaid, Medicare, and commercial lines—providing deep expertise in coding, billing, and reimbursement Collaborate cross-functionally with Product and Engineering to improve tooling, streamline development workflows, and enhance overall content delivery 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 Provide payment policy and medical coding expertise to help create and maintain claim edits, including recommendations for configuration criteria for edit sustainability Assist with research to identify opportunities for new policies, including performing medical coding analysis Work across the Content team to provide medical coding expertise to resolve customer inquiries regarding claim edit application Assist in creating and maintaining documentation for Rialtic’s policy content library Collaborate cross-functionally with Product and Engineering to identify automation opportunities, improve tooling, streamline development workflows, and enhance overall content delivery