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Rialtic, Inc. • Atlanta, Georgia, United States
Role & seniority: Associate Claims Validation Analyst (mid-level, individual contributor)
Stack/tools: Healthcare policy references (CMS, AMA, NCCI, OIG, LCDs/LCAs), data validation and testing; Google Workspace; Amazon Workspace; Jira; data analysis; require ability to learn software/tools with minimal guidance
Review and interpret Medicaid/Medicare/Commercial policy for coding and billing guidelines; translate into validated claims edits
Collaborate with concept creation, engineering, and data teams; build unit tests; develop and validate edits with data
Conduct in-depth policy research, validate edits against official documents, and monitor ongoing alignment with billing standards
4+ years in healthcare (familiar with medical coding terminology and claims)
Experience with a payer or editing vendor; knowledge of payment accuracy (pre/post-payment)
Proficient in self-directed learning of software tools (Google Workspace, Jira, etc.)
Strong collaboration/communication across Engineering, Product, Content teams
Remote work capability; self-starter with ability to meet weekly productivity/quality goals
National coding/billing credentials (CPC, CCS-P, RHIA, CCS, CPB)
SQL query-building and data-mining for claims analysis
Experience reading Medicare/Medicaid data, policies, and updating payment accuracy guidelines
Experience applying CPT/Medicare/Medicaid policy
About Rialtic Rialtic is an enterprise software platform empowering health insurers and healthcare providers to run their most critical business functions. Founded in 2020 and backed by leading investors including Oak HC/FT, F-Prime Capital, Health Velocity Capital and Noro-Moseley Partners, Rialtic's best-in-class payment accuracy product brings programs in-house and helps health insurance companies gain total control over processes that disparate and misaligned vendors have managed. Currently working with leading healthcare insurers and providers, we are tackling a $1 trillion problem to reduce costs, increase efficiency and improve quality of care. For more information, please visit www.rialtic.io. The Role As a Associate Claims Validation Analyst with Rialtic you’ll research and interpret CMS, CPT/AMA, and other major payer policies in accordance with healthcare 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 every day 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. This is an exciting opportunity if you are interested in taking your healthcare experience and growing your technical skills by gaining advanced knowledge in the SaaS healthcare tech space.
Proficient Computer skills: Ability to self-learn Google Workspace, Amazon Workspace, Jira, and other software with minimal guidance
Collaboration Skills: Ability to communicate & collaborate with different departments such as Engineering & Product teams.
Nationally recognized coding or billing credentials: CPC, CCS-P, RHIA, CCS, CCS-P, CPB SQL query-building and lookup skills for claims data analysis and data mining for editing opportunitiesExperience reading and analyzing Medicare/Medicaid data and policy, which includes fee schedules, CCI, OIG Alerts, LCAs/LCDs, NCDs. Experience reading Medicare/Medicaid policies and applying industry coding guidelines to claim processes Reading updated policy (e.g., CPT, Medicare, Medicaid) and updating existing payment accuracy guidelines (Maintenance) We are headquartered in Atlanta, but we are remote-friendly. Don’t meet every single requirement? Studies have shown that women and people of color are less likely to apply to jobs unless they meet every single qualification. At Rialtic, we are dedicated to building a diverse, inclusive and authentic workplace, so if you’re excited about this role but your experience doesn’t align perfectly with every qualification in the job description, we encourage you to apply anyway. You may be just the right candidate for this or other roles.