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Senior Manager, Content Performance – Coding Compliance
Location
United States
Posted
38 days ago
Salary
0
Seniority
Senior
Job Description
Senior Manager, Content Performance – Coding Compliance
Rialtic
• 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
Job 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
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