Senior Manager, Content Performance & Coding Compliance

Rialtic • Atlanta, GA

1d • Hybrid

About The Position

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.

Requirements

• 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.
• Strong understanding 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 use in policy and reimbursement logic.
• Knowledge of CMS, Medicaid, and ACA guidelines and how they inform content strategy and compliance.
• Ability to interpret large datasets; experience collaborating with data science teams on fraud, waste, and abuse detection or pattern recognition.
• Skilled in building scalable processes, identifying automation solutions, and delivering continuous quality improvements.
• Understanding of how clinical content is deployed and managed within rule engines and claims editing platforms.
• Experience leading small teams, mentoring talent, and delivering outcomes in high-change environments.
• Comfortable operating in dynamic settings with evolving priorities and a limited predefined process.
• Strong written and verbal communication skills for cross-functional collaboration and stakeholder alignment
• Comfort with modern asynchronous communication tools such as Slack, Zoom, and other documentation solutions such as Notion and Google Drive.

Nice To Haves

• 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).
• 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

Responsibilities

• 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
• 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
• 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
• 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

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

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Number of Employees: 11-50 employees