Healthcare Payment Integrity Analyst – Policy & Content Management

November 4

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Rialtic

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Healthcare Insurance • SaaS • Fintech

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

• Interpret and translate complex CMS, AMA/CPT, and commercial payer policies into actionable claims editing logic that drives measurable payment accuracy • Leverage data-driven insights to identify and make recommendations for new policy opportunities • Own the development of precise, high-quality edit specifications in close partnership with Engineering to ensure seamless implementation. • Act as a subject matter expert across Medicaid, Medicare, and commercial lines—providing deep expertise in coding, billing, and reimbursement. • Maintain and enhance existing content by proactively monitoring and applying regulatory and policy updates for the Policy and Content Management team on our payment integrity teams. • Ideate and scope policy for our clients. • Analyze performance data to confirm the efficacy of edits, and clearly document the rationale and results to support both internal and external stakeholders. • Collaborate cross-functionally with Product and Engineering to improve tooling, streamline development workflows, and enhance overall content delivery. • Independently manage the end-to-end lifecycle of content edits—from research and ideation through deployment and post-release validation. • Stay current on evolving healthcare regulations and coding guidelines to ensure Rialtic’s logic remains comprehensive and compliant. • Consistently exceed productivity and quality targets while thriving in a remote, outcomes-driven environment.

🎯 Requirements

• Bachelor’s degree preferred in Healthcare, Technology, or a related field • 4+ years of experience in healthcare coding, billing, or payment accuracy • National coding credential: CPC, CCS-P, RHIA, CCS, CPB or equivalent • Deep familiarity with CMS policies (LCAs, LCDs, NCDs), CCI edits, OIG alerts, fee schedules • Strong understanding of claims processing workflows (CMS-1500, UB-04) • Prior experience developing or managing claims edits in a pre- or post-pay context • Comfortable collaborating with engineering and product in a tech-forward environment • Intermediate Excel skills (pivot tables, VLOOKUP, functions)

🏖️ Benefits

• Remote-first flexibility and home office stipend • Meaningful equity and 401(k) match • Open and Flexible PTO Plan, comprehensive medical/dental/vision plans • Wellness reimbursements and access to TalkSpace, Teladoc, and One Medical