Payment Integrity Content Portfolio Manager - Drugs and Biologicals

April 1

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Rialtic

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Rialtic is a next-generation healthcare technology company focused on making healthcare more efficient. The company offers a cloud-based SaaS platform designed to improve payment accuracy within the healthcare system. Rialtic's platform enables healthcare payers and providers to save on administrative expenses and medical costs through transparent and comprehensive edits, enhancing provider collaboration with self-service configurations and reporting. By streamlining on-premise solutions into a single user-friendly platform, Rialtic helps organizations manage workflows, minimize redundancies, and promote cross-team collaboration. The platform provides powerful analytics, allowing users to monitor performance and identify new savings opportunities, thus driving healthcare innovation through technology.

51 - 200 employees

⚕️ Healthcare Insurance

☁️ SaaS

💳 Fintech

📋 Description

• Please note that this role requires working EST hours and can only consider East coast candidates. • Rialtic is on a mission to create a better healthcare system by reducing administrative costs, increasing efficiency and empowering payers and providers to focus on delivering the best care possible. • Our initial offering is a next-gen enterprise technology platform that will dramatically reduce complexity, save money and increase speed and accuracy for healthcare claims processing and adjudication. • We have an ambitious roadmap to tackle some of the biggest problems across healthcare technology. • Founded in 2020, Rialtic has raised over $15mm from investors, including leading healthcare technology investor, Oak HC/FT. • This role is perfect for someone who is passionate about transforming healthcare technology through data-driven insights and has a strong understanding of the FDA drugs area. • You will manage the FDA Drugs and Biologicals portfolio. • This is a position for a content portfolio manager to manage the FDA Drugs and Biologicals portfolio including scoping, design, and QC. • The role will manage on and offshore resources working on the portfolio including designers, QC, and maintenance - and do the work as well. • The person will also serve as an expert to address pharmacy-related client needs. • This includes 50% doing the work to develop professional edits for drugs and biologicals, 40% managing the initiatives, and 10% providing subject matter expertise.

🎯 Requirements

• 4-6 years of work experience in payment integrity with a health plan or claims editing vendor with a focus on drugs and biologicals • Medical coding certification from AAPC, AHIMA, or other body, equivalent medical coding/billing college degree • Experience making medical coding edits for drugs and biologicals for claims editing vendor and/or payer • Experience reading and interpreting FDA drug labels, clinical/academic journals, and special societies guidelines to create medical coding edits for drugs and biologicals for professional claims including on and off-label indications • Expertise with National Drug code data and edits for National Medicare and State Medicaids • Coding, Billing, and/or Auditing Credentials or any certified coding specialty • Advanced Google Suite skills • Deep knowledge of claims edits’ top error reasons, client value, and analytics • Expert in interpreting medical policies and applying correct coding guidelines • Expertise in multiple medical coding and/or billing specialties • Expertise in professional and institutional claims • Experience explaining medical policies and payment accuracy to clients • Managed claims editing implementations • Strong verbal communication skills • Experience presenting on client calls, answering client questions, and negotiating client requests with internal resources.

🏖️ Benefits

• Freedom to work from wherever you work best and a home office stipend to make it happen • Meaningful equity and 401k matching • Unlimited PTO and wellness reimbursements • Comprehensive health plans with generous contribution to premiums • Mental and physical wellness support through TalkSpace, Teladoc, and One Medical subscriptions