Job description
Client Payment Integrity Policy Manager
Overview
As a Client Payment Integrity Policy Manager, you will serve as a trusted partner to our clients, helping them optimize and manage their claims editing portfolios to maximize identification of potential overpayments. This role sits at the intersection of client engagement, healthcare payment policy expertise, and strategic content management. You will not only respond to client needs but also guide them toward approaches that generate maximum long-term value, balancing immediate requests with what drives the greatest impact for their long-term business outcomes.
You will work closely with client management, product, engineering, and strategic content leadership—deeply embedded in both our client and internal teams. This is an opportunity to combine subject matter expertise with consultative influence, helping clients transform how they manage payment integrity policies while advancing the overall roadmap of our platform.
Responsibilities
Client Partnership & Policy Expertise
- Act as the primary subject matter expert and trusted advisor to clients on payment integrity policies and claims editing.
- Creatively tailor and fine-tune policies to client-specific circumstances, ensuring maximum savings while minimizing provider abrasion.]
- Guide clients to balance short-term requests with long-term strategies that generate sustainable impact.
- Present and explain policy rationale, value, and implications during client interactions.
Strategic Value & Insights
- Prioritize and recommend policies based on savings potential, client needs, and strategic alignment.
- Quantify and clearly communicate the value of policies using data-driven analysis.
- Identify adoption gaps, inefficiencies, or emerging opportunities and work with clients to address them.
Cross-Functional Collaboration
- Partner with Client Success to integrate into client workflows and decision-making.
- Communicate client policy needs in a way that informs and shapes product requirements, influencing the roadmap where appropriate.
- Collaborate with product, engineering, and content leadership to ensure client perspectives are reflected in platform evolution.
Execution & Delivery
- Oversee policy implementation processes, ensuring accuracy, timeliness, and measurable results.
- Develop clear, client-facing content materials, analyses, and reporting.
- Track and report on client adoption trends, decisions, and outcomes.
Qualifications
Required
- 5-7 years of work experience in payment integrity at a health plan, claims editing vendor, or similar environment.
- Coding, billing, or auditing credentials (e.g., CPC, CCS, or equivalent specialty certifications). A certification in coding is mandatory for this position.
- Expertise in interpreting medical policies, applying correct coding guidelines, and understanding the top claims error reasons.
- Demonstrated experience advising clients and explaining complex medical policy/payment accuracy concepts.
- Strong analytical skills with the ability to quantify and communicate policy value.
- Proven experience managing claims editing implementations or similar client delivery initiatives.
Preferred
- Expertise across both professional and institutional claims.
- Advanced skills with Google Suite or similar tools.
- Experience working cross-functionally with product and engineering teams.
- Excellent written and verbal communication skills with strong influencing ability.
Studies have shown that women and people of color are less likely to apply for jobs unless they meet every single qualification.
At Rialtic, we are dedicated to building a diverse, inclusive, and authentic workplace. If you’re excited about this role but your past experience doesn’t align perfectly with every qualification in the job description, we encourage you to apply anyway. You may be just the right candidate for this or other roles.
About Rialtic’s Benefits:
- Freedom to work from wherever you work best and a home office stipend to make it happen
- Meaningful equity and 401k matching
- Open PTO plan and wellness reimbursements
- Comprehensive health plans with generous contribution to premiums
- Mental and physical wellness support through TalkSpace, Teladoc, and One Medical subscriptions
We are headquartered in Atlanta, but we are remote-friendly.
Don’t meet every single requirement?
Rialtic is an equal-opportunity employer. All applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, or genetic information. We cannot access your personal Equal Employment Opportunity Commission information during the interview process. Rialtic is committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. To request a reasonable accommodation, please let us know in your application or email us.
Please take the necessary steps to allow listing of the Rialtic (@Rialtic.io) and Greenhouse (@Greenhouse.io) domains so that you receive all emails related to your application process. Also, please make sure to check your spam folder as emails from Greenhouse can be marked as spam.
TO ALL RECRUITMENT AGENCIES: Rialtic does not accept agency resumes. Please do not forward resumes to Rialtic employees or any other company location. Rialtic is not responsible for any fees related to unsolicited resumes and will not pay fees to any third-party agency or company that does not have a signed agreement with the Company for this specific role.
