PAYMENT INTEGRITY •CONTENT STRATEGY
Clinical Content Strategy Manager
Turn claims data, coding change, and market intelligence into our next generation of edits.
| POSTING TITLE | Payment Integrity Analytics & Strategy Manager |
| TEAM | Content Strategy & Portfolio Management |
| LOCATION | Remote (US) — Eastern or Central time zone preferred |
| TYPE | Full-time, exempt |
ABOUT RIALTIC
Rialtic is the transparent pre-pay editing platform for payers. Rialtic Edits pairs an expert-curated policy library with a cloud-native platform that delivers real-time, automated claims editing — where every policy and every denial is explainable, traceable, and audit-ready. Our Super Agents extend that work across the full payment lifecycle, pairing deterministic rules with agentic inference and human-in-the-loop validation so payers and providers improve payment accuracy without giving up oversight. Agents recommend; our clients decide.
Clients see a 2–4% reduction in medical spend and a 15–25% reduction in annual administrative expense. Rialtic is backed by Oak HC/FT, F-Prime Capital, Health Velocity Capital, Noro-Moseley Partners, UPMC, and Socium Ventures, and recently announced a strategic merger with Exponential AI to advance payment accuracy and decision intelligence. The platform is HITRUST CSF r2 Certified and SOC 2® Type II compliant. We are headquartered in Atlanta with an office in Hyderabad. Learn more at rialtic.com.
THE ROLE
We're looking for a highly analytical healthcare professional to lead strategic editing initiatives through market intelligence, coding and reimbursement analysis, claims data mining, and healthcare trend analytics. You'll be the bridge between data, clinical policy, payment integrity strategy, and product development — identifying opportunities for new clinical edits, policy enhancements, and revenue protection programs across Commercial, Medicare, and Medicaid populations.
Your work feeds directly into both sides of our platform: the curated policy library behind Rialtic Edits, and the Super Agents that pair deterministic rules with agentic inference across payment accuracy, prior authorization, and audit and appeals.
The ideal candidate pairs deep payment integrity and clinical editing expertise with the analytical range to turn claims data, coding updates, regulatory change, and emerging market trends into actionable content strategy. You'll partner closely with Content, Product, Clinical, Technology, and Client teams to drive the development and prioritization of next-generation payment integrity solutions.
WHAT YOU'LL DO
Strategic editing opportunity development
- Identify, evaluate, and prioritize new clinical editing opportunities through analysis of claims data, provider billing patterns, reimbursement trends, and market intelligence.
- Develop data-driven recommendations for payment integrity initiatives that improve savings, payment accuracy, and client outcomes.
- Monitor emerging healthcare trends, utilization patterns, and regulatory change to identify areas for content and policy expansion.
- Support long-term editing and policy roadmaps through market and competitive analysis.
Claims data mining and analytics
- Analyze large-scale professional and facility claims datasets to uncover inappropriate billing patterns, reimbursement inconsistencies, and emerging opportunities.
- Quantify potential financial impact, savings opportunity, provider abrasion risk, and implementation feasibility.
- Build predictive and retrospective analyses that support strategic decision-making and content prioritization.
- Create dashboards, reports, and executive summaries that communicate findings to leadership and clients.
Clinical policy and editing strategy
- Optimize the workflows that translate regulations, coding changes, reimbursement updates, and clinical guidance into actionable policy recommendations.
- Evaluate opportunities generated from CPT updates, ICD-10 coding changes, HCPCS revisions, CMS policy changes, Medicare and Medicaid guidance, commercial payer reimbursement trends, and client-specific utilization patterns.
- Partner with clinical and content teams to define business requirements and implementation strategies for new edits.
Market intelligence and cross-functional leadership
- Monitor industry publications, coding updates, CMS releases, payer bulletins, and reimbursement guidance.
- Assess competitive offerings and identify gaps that innovative editing and policy solutions can address.
- Evaluate partnerships, third-party content opportunities, and emerging technologies that support payment integrity initiatives.
- Collaborate with Content, Product, Engineering, Clinical, and Client Success to advance initiatives from concept through implementation.
- Present opportunities, findings, and recommendations to senior leadership and client stakeholders.
WHAT YOU BRING
- Bachelor's degree or equivalent experience.
- 5+ years in healthcare analytics, payment integrity, clinical policy, or clinical editing.
- End-to-end experience supporting Commercial, Medicare, and Medicaid payment integrity programs.
- A track record of identifying and developing new editing opportunities through data analysis and clinical policy review.
- Proven ability to translate complex healthcare data into strategic recommendations.
Healthcare knowledge
- Professional and facility claim processing, payment integrity methodologies, clinical editing systems, and claims auditing and validation.
- Medicare and Medicaid reimbursement methodologies, commercial payer policy frameworks, revenue cycle management, and clinical policy development.
Technical skills
- An AI-enabled mindset and curiosity about where automation can extend your reach.
- Advanced SQL and experience working with large healthcare claims datasets.
- Strong analytical and visualization skills using data mining tools and Excel.
- Familiarity with Python, SAS, or comparable healthcare analytics platforms.
Coding and reimbursement expertise
- Working knowledge of ICD-10-CM, CPT, HCPCS, DRG, APC, and NCCI.
- Familiarity with CMS payment methodologies, national and local coverage determinations, and provider billing and coding practices.
NICE TO HAVE
- Certified Professional Coder (CPC) certification.
- Project Management Professional (PMP) certification.
HOW WE'LL MEASURE SUCCESS
- A sustainable pipeline of high-value editing opportunities.
- New payment integrity initiatives surfaced through market intelligence and data mining.
- Better prioritization of content investments using data-driven methodology.
- Actionable trend analysis that supports strategic product and policy expansion.
- Organizational strategy influenced by insight drawn from claims analytics, coding updates, and reimbursement intelligence.
IS THIS YOU?
This role suits someone who enjoys answering questions like:
- What editing opportunities are emerging from current client claims data?
- Which coding updates create new payment integrity opportunities?
- Where are providers billing differently than expected?
- What market trends should drive our next policy investments?
- Which initiatives will generate the greatest value for our clients?
- How should strategic editing resources be prioritized to maximize impact?
WHY YOU'LL LOVE IT HERE
Rialtic is making healthcare payments more accurate, transparent, and efficient through governance-native agentic AI. If you're driven by meaningful work, bold ideas, and the chance to improve an industry that touches millions of lives, you'll feel at home here. One team, driven by integrity and curiosity.
At Rialtic, our values matter. They describe how we work together and how we want others to experience us. We live and breathe them every day in service of our clients:
- High Integrity — Do the right thing. Be candid, humble, and respectful.
- Customer Value Comes First — Delivering value to our clients is our North Star.
- Work as One Team — A collaborative, inclusive environment to advance our mission.
- Be Bold & Accountable — Speak up, take ownership, and keep improving.
- 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.
Open paid time off and flexible schedules. 95% of employee premiums covered on medical, dental, and vision plans. Everyone on the team is an owner through meaningful equity, plus 401(k) with company matching. Disability and life insurance, HSAs, One Medical membership, and mental and emotional wellbeing benefits. Join us at our Atlanta HQ or work remotely — fully remote team members receive a home office allowance.
DON'T MEET EVERY QUALIFICATION?
Studies show that women and people of color are less likely to apply to jobs unless they meet every qualification listed. At Rialtic, we're building a diverse, inclusive, and authentic workplace — if you're excited about this role but your experience doesn't align perfectly with every qualification, we encourage you to apply anyway. You may be just the right candidate for this or another role.
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. To request a reasonable accommodation, please let us know in your application.