Payment Integrity Content Portfolio Manager, Drugs and Biologicals

*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. Come join our team to build the best technology in healthcare and change the way the healthcare industry operates.

• Content Portfolio Manager, Drugs and Biologicals

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. You will be a member of the Content Creation pod within the Content Department at Rialtic.

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. 

You will:

• Understand how to interpret FDA drug labels and clinical articles to create correct coding drugs and biological edits for professional claims
• Create, review and maintain edits
• Educate, mentor and coach content analysts on creating and delivering quality output
• Develop timelines for initiatives and manage teams to meet deliverables
• Ensure policy requests are understood, addressed, and executed as determined
• Explain drugs and biologicals policy edits to clients
• Increase policy adoption and drive savings rates for drugs and biologicals edits
• Review Medicare, Medicaid, commercial, FDA, NDC and other sources to determine correct coding edits to design
• Create and manage special projects and programs from concept through execution and maintenance
• Provide expertise to guide the prioritization and roadmap of edits pertinent to your top knowledge areas
• Develop a Roadmap to guide the creation of your portfolio of claims processing edits
• Validate edits with claims data
• Troubleshoot edits that do not function as expected and collaborate with Engineering teams to resolve and adjust design and test claims to make edits function as intended.

We’re looking for someone who has:

• 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.

At Rialtic, our values matter. They describe how we work together and how we want others to experience us. We live and breathe these values every day in service of our clients.

• High Integrity
• Do the right thing. Provide candid feedback. Be humble and respectful.
• Customer Value Comes First<