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Senior Manager, Content Performance & Coding Compliance

at Rialtic, Inc.

Atlanta or Remote

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 product brings programs in-house and helps health insurance companies gain total control over processes that disparate and misaligned vendors have managed. Currently working with leading healthcare insurers and providers, we are tackling a $1 trillion problem to reduce costs, increase efficiency, and improve quality of care. For more information, please visit www.rialtic.io.

The Senior Manager, Content Performance & Coding Compliance, will strategically leverage quality trends, client data, and content sources to drive E2E performance improvement of Rialtic's content development process and ensure coding compliance. This is a foundational leadership role within a high-growth startup, requiring a dynamic leader who blends thought leadership with decisive execution, thrives in ambiguity, and builds structure in fast-evolving environments. 

We're looking for a hands-on, forward-thinking leader who understands the payer-centric landscape, embraces new ways of working, and brings a sharp sense of tempo and adaptability to everything they do. This person will help reimagine how content is created, deployed, and governed - using modern tooling, including AI-enabled solutions, to scale effectively.

Success in this role demands both creativity and rigor, a collaborative spirit, and a mindset oriented toward performance and compliance. You will work cross-functionally to embed process improvement, automation solutions, and continuous quality improvement into Rialtic's content development and management efforts, ensuring a consistent, high-value experience for our customers.

Team Development

• 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

Policy Inquiry Support

• 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

Performance Improvement 

• 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

Coding Compliance 

• 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

• 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.
  

• Claims Adjudication: Strong understanding of commercial, Medicare, and Medicaid claims workflows, including pre- and post-pay integrity processes.
• Medical Coding: Proficient in ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Level II coding and their use in policy and reimbursement logic.
• Regulatory Policy: Knowledge of CMS, Medicaid, and ACA guidelines and how they inform content strategy and compliance.
• Analytical Skills: Ability to interpret large datasets; experience collaborating with data science teams on fraud, waste, and abuse detection or pattern recognition.
• Performance Improvement: Skilled in building scalable processes, identifying automation solutions, and delivering continuous quality improvements.
• Technical Workflow: Understanding of how clinical content is deployed and managed within rule engines and claims editing platforms.
• Team Leadership: Experience leading small teams, mentoring talent, and delivering outcomes in high-change environments.
• Adaptability: Comfortable operating in dynamic settings with evolving priorities and a limited predefined process.
• Communication: Strong written and verbal communication skills for cross-functional collaboration and stakeholder alignment
• Remote Work: Comfort with modern asynchronous communication tools such as Slack, Zoom, and other documentation solutions such as Notion and Google Drive.
  

• Experience with commercial, Medicare Advantage, and/or Medicaid plans.
• Certified Professional Coder (CPC) or similar credential.
• Hands-on experience working with policy authoring tools, claims databases, SQL-based analysis platforms, or BI tools (e.g., Looker, Tableau).

Nice to have:

• Nationally recognized coding or billing credentials: CPC, CCS-P, RHIA, CCS, CCS-P, CPB
• SQL query-building and lookup skills for claims data analysis and data mining for editing opportunities
• Claims editing experience
• Project Management experience
• Experience with mapping CMS 1500, EDI and FHIR

Rialtic Values

• High Integrity
• Do the right thing. Provide candid feedback. Be humble and respectful.
• Customer Value Comes First
• Delivering value to our customers is our North Star.
• Work as One Team
• Collaborative, inclusive environment to advance our mission.
• Be Bold & Accountable
• Speak up. Take accountability. Continually improve.
• Pursuit of Excellence
• Innovate, iterate and chase the best possible outcomes.
• Take Care of Yourself & Others
• Prioritize the health and wellbeing of yourself and your teammates.

Rialtic 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

We are headquartered in Atlanta, but we are remote-friendly.

Don't meet every single requirement?

Studies have shown that women and people of color are less likely to apply to jobs unless they meet every single qualification.

At Rialtic, we are dedicated to building a diverse, inclusive, and authentic workplace, so 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 role or others.