Healthcare Content Portfolio Analyst

December 12, 2023

Rialtic

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We are on a mission to make healthcare more efficient.

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Description

• If you describe yourself as a healthcare coding and billing policy geek who is passionate about payment accuracy and integrity, then this is the dream job you’ve been looking for. As a Healthcare Content Analyst, you’ll research and interpret CMS, CPT/AMA and other major payer policies based on healthcare correct coding and regulatory requirements. You’ll identify common error areas that can be made into automated software logics that prevent overpayments from occurring. You’ll take your edits from concept to specification and then through review, testing and finally data validation - along the way you’ll collaborate with some of the smartest minds in healthcare policy and technology. Your goal everyday is to develop claims editing logics that promote payment accuracy and transparency across Medicaid, Medicare, and commercial lines of business. You’ll increase your revenue cycle acumen as you identify ways to turn resource excerpts into claims processing rules that educate payers and providers on why a claim should not be paid.

Requirements

• 2-5+ years of claims editing experience with healthcare payers and/or claims editing software vendors • Nationally recognized coding or billing credential required: CCS, CCS-P, CPC, CPB • Billing, coding, revenue cycle, and claims editing software experience • Experience in claims adjudication and application of NCCI editing and multiple payment rules • Ability to interpret claim edit rules and references • Solid understanding of claims workflow including the interconnection with claim forms • Bonus: Intermediate level proficiency mapping CMS 1500, EDI and FHIR • Ability to apply industry coding guidelines to claim processes • Proven experience reviewing, analyzing, and researching coding issues for payment integrity • Logics skills: ability to break policy edits down into decision making paths • Ability to troubleshoot and apply root-cause analysis of logics not functioning as intended • Computer skills: ability to use Google Work Space, Amazon Work Space, Jira, SmartDraw and other software with minimal training • Intermediate level proficiency in Excel (ability to manipulate data using excel functions along with pivot tables, v-look up, etc) • Excellent verbal & written communication skills • Bonus: SQL query-building and lookup skills

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 healthcare benefits • Take Care of Yourself & Others • High Integrity • Customer Value Comes First • Work as One Team • Be Bold & Accountable • Pursuit of Excellence