Rialtic logo
Rialtic

We are on a mission to make healthcare more efficient.

Payment Accuracy Manager, Outpatient Facility

ManagerManagerFull TimeRemoteSeniorTeam 51-200H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

6 days ago

Salary

Not specified

Seniority

Senior

Professional Certificate5 yrs expEnglish

Job Description

• 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

Job Requirements

  • 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)

Benefits

  • Health insurance
  • Professional development opportunities

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