Senior Manager, Content Performance – Coding Compliance

📋 Description

• Develop and lead a high-performing team of Content Policy Managers and Analysts.

• Act as a player-coach by fostering an environment of ownership, resilience, and accountability—while avoiding micromanagement.

• Investigate potential policy defects and address inquiries from clients and colleagues throughout the organization.

• Identify and troubleshoot policy defects, collaborating with Content and Engineering teams to modify and resolve policy designs to achieve the desired functionality.

• Conduct root cause analysis (RCA) of identified policy defects to ascertain additional controls necessary for driving end-to-end continuous quality improvement.

• Proactively utilize policy utilization trend data to monitor, analyze, and mitigate anomalies in insight rates.

• Use combined data on policy defects and utilization trends to identify and implement process changes, automation/tooling enhancements, and scalable, AI-enabled strategies to enhance efficiency and quality throughout the end-to-end Content development process.

• Collaborate with Product and Engineering teams to define and implement strategic enhancements to the Content platform.

• Maintain a strong sense of urgency while ensuring quality in all tasks.

• Oversee the continual upkeep of Rialtic’s policy library to guarantee policies remain accurate and current with source changes.

• Manage the implementation of new CPT, HCPCS, and ICD-10 codes within Rialtic’s policy library.

• Administer Rialtic’s subscriptions to Content reference sources and act as the vendor relationship manager.

⛳️ Requirements

• A Bachelor’s degree in healthcare administration, finance, or a related field; a Master’s degree or MBA is preferred.

• At least 5 years of experience in healthcare, with a minimum of 2-3 years in a leadership role within Payment Integrity or Claims Operations.

• Experience from both payer and provider perspectives is highly desirable.

• Strong knowledge 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 application in policy and reimbursement logic.

• Familiarity with CMS, Medicaid, and ACA guidelines and their impact on content strategy and compliance.

• Capability to interpret large datasets; experience working with data science teams on fraud, waste, and abuse detection or pattern recognition.

• Expertise in developing scalable processes, identifying automation solutions, and implementing continuous quality improvements.

• Understanding how clinical content is managed and deployed within rule engines and claims editing platforms.

• Experience in leading small teams, mentoring talent, and achieving results in fast-paced environments.

• Comfortable working in dynamic settings with shifting priorities and minimal predefined processes.

• Excellent written and verbal communication skills for effective cross-functional collaboration and stakeholder engagement.

• Familiarity with modern asynchronous communication tools such as Slack, Zoom, and documentation solutions like Notion and Google Drive.

🏝️ Benefits

• Flexibility to work from your preferred location along with a home office stipend to support your setup.

• Meaningful equity participation and a 401(k) matching program.

• Unlimited paid time off (PTO), comprehensive health plans, and wellness reimbursements.

• Generous contributions to premiums as part of our comprehensive health plans.

• Mental and physical wellness support through subscriptions to TalkSpace, Teladoc, and One Medical.