The Role:

Clinical Expertise:

• Leverage your extensive clinical knowledge to guide the development and improvement of our payment accuracy algorithms, rules engines, and claims analysis models.
• Act as the subject matter expert for medical claim processing, ensuring that our solutions align with industry best practices, regulatory requirements, and advanced analytics. You will serve as a thought leader in the payment accuracy space. Working with product and GTM to build the things that would be most valuable for our clients. You will be providing clinical guidance and input.

Strategic Leadership:

• Collaborate with the Chief Medical Officer and executive team to develop and execute a strategic roadmap for the company's growth and impact in the realm of rules engines and claims analysis.
• Provide input on product development, market positioning, and customer engagement strategies, with a focus on enhancing the capabilities of our rules engines.
• Serve on our leadership team.

Content Development:

• Lead the creation and curation of healthcare content, ensuring that it is accurate, up-to-date, and tailored to support rules engines and claims analysis.
• Oversee the content team to develop educational resources, articles, and materials for clients and internal stakeholders, emphasizing their relevance to our analytical tools.

Data-Driven Decision Making:

• Utilize your analytical skills to develop actionable insights that drive improved payment accuracy through rules engines, claims analysis and payor specific trend analytics.
• Work closely with our data science and engineering teams to refine and enhance our analytics tools, integrating rules-based decision-making processes.

Client Engagement:

• Build and maintain strong relationships with clients, understanding their specific needs and challenges related to medical claim payment accuracy and the role of rules engines and claims analysis.
• Serve as a trusted advisor to clients, offering guidance and expertise on healthcare payment matters within the context of rules engines.
• Supporting the GTM areas including participation in prospective client sales process; implementation activities and ongoing client experience.

Regulatory Compliance:

• Stay up-to-date with changes in healthcare regulations and compliance requirements, ensuring that our content, rules engines, and claims analysis remain compliant and aligned with industry standards.

Team Development:

• Foster a collaborative and innovative culture within the content team, providing mentorship and support to team members as they contribute to rules engines and claims analysis efforts.
• Lead by example, demonstrating a commitment to our company values and mission in the context of advanced analytics.

Qualifications:

• Medical Doctor (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree.
• Board certification in a relevant medical specialty preferred.
• Minimum of three years of clinical practice experience.
• Strong background in healthcare content development, rules engines, and claims analysis. Payor experience including Medicare, Medicaid and commercial lines of business is a strong plus.
• Experience working in a startup or entrepreneurial environment is a plus.
• Excellent communication and interpersonal skills.
• Passion for improving healthcare payment accuracy and patient outcomes through advanced analytics and rules engines.
• Alignment with Rialtic's values

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 401k matching
• Unlimited PTO, comprehensive health plans and wellness reimbursements
• Comprehensive health plans with generous contribution to premiums
• Mental and physical wellness support through TalkSpace, Teladoc and One Medical subscriptions