Claims Analytics Manager leading claims analytics and overseeing reimbursement analyses at Rialtic, Inc. Mentoring a team and collaborating cross-functionally for client implementations.
Responsibilities
Lead and mentor a team of Implementation Claims Analysts, setting priorities, performance expectations, and development plans.
Define and standardize analytical methodologies, reporting frameworks, and best practices for claims and reimbursement analysis.
Partner with Implementation leadership to align analytics deliverables with client goals, timelines, and success metrics.
Act as a subject-matter expert in claims analytics for complex or high-visibility client implementations.
Oversee large-scale analysis of claims data related to charge capture, reimbursement, underpayment, overpayment, and payment accuracy.
Ensure the delivery of exception-driven, actionable insights that clearly identify systemic versus isolated issues.
Review and validate analytical outputs, ensuring accuracy, consistency, and clarity in reporting and client-facing deliverables.
Guide analyses related to payor reimbursement behavior and trends, RVU productivity and payment alignment, revenue cycle optimization opportunities, and financial performance to benchmarks, goals, and norms.
Partner with GTM and Customer Success teams to support implementations, renewals, and expansion opportunities through analytics insights.
Requirements
8+ years of experience in healthcare claims analytics, payment accuracy, or reimbursement analysis.
Prior experience working with claims editing or payment accuracy vendors.
Strong expertise in medical coding, billing guidelines, and reimbursement methodologies.
Proven people leadership experience managing and developing analytics teams.
Advanced proficiency in SQL and experience working with large healthcare datasets.
Strong executive communication and presentation skills.
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