Content Policy Manager

Content Policy Manager, Research and Scoping Payment Integrity | Rialtic, Inc. ABOUT RIALTIC Rialtic is an enterprise software platform empowering health insurers and healthcare providers to run their most critical business functions. Founded in 2020 and backed by leading investors including Oak HC/FT, F-Prime Capital, Health Velocity Capital, and Noro-Moseley Partners, Rialtic's best-in-class payment accuracy platform brings programs in-house and helps healthcare organizations gain full control over processes traditionally managed by fragmented vendors. Today, we partner with leading healthcare insurers and providers to tackle a $1 trillion problem — reducing costs, increasing efficiency, and improving quality of care. Learn more at www.rialtic.io. THE ROLE As a Payment Accuracy Policy Manager, you will serve as a critical bridge between healthcare payment expertise, client strategy, and product innovation. 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. 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 while building the content foundation that powers our enterprise platform. WHAT YOU'LL DO • 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. WHAT YOU BRING • 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 interpreting medical and payment policies, applying CMS and Medicaid reimbursement guidelines, professional and outpatient coding…