Payment Accuracy Claims Analyst

You will be responsible for:

The Facility Edits Claims Analyst will report directly to the Director of Content at Rialtic. You will be responsible for designing, validating, and maintaining our Policy Library which provides healthcare medical claims edits for payers. On a daily basis, you will read Institutional and Professional coding policy source documents from Medicare and Medicaid to create the design structure our technology relies on.

You will be challenged to find new ways to mine data and identify new opportunities for source-based rules while maintaining Policies for our Payment Accuracy Library. Collaborating with content managers, the medical director, and engineers will be the norm.

In addition, you will:

• Analyze policies and claims database to identify patterns of inaccurate payment accuracy and opportunities for creating new source document-based rules
• Understand and apply medical coding guidelines to institutional and professional source documents not limited to Medicare, Medicaid, and Commercial insurers
• Ensure adherence to quality assurance guidelines
• Translate the documents' coding guidelines into a structured design that engineers develop into software - medical claims edits
• Work closely with a team of experts with extensive medical claims experience
• Enter design details into content management software including data entry, downloading, and attaching source documents
• Test and validate changes made to the content
• Serve as a subject matter expert for content and edits and provide support where needed
• Research, build analyze, and test edits to be used in the Claims Editing library
• Utilize strong coding and industry knowledge to research regulatory updates, create and maintain editing content (data used by the edits)

Required Qualifications

• Comfortability using Jira, Google Apps (Google Docs, Google Sheets), Notion, Slack, and Content management software.
• Participation in turning medical coding policies into structured design for software development
• Exceptional analytical and problem-solving skills; able to analyze processes and information, identify problems and trends
• Current certified coder (CCS, CIC, COC, CASCC, and/or CPC)
• Strong attention to detail and follow-up skills/strong interpersonal skills; ability to relate with different personalities
• Knowledge of institutional medical coding and billing guidelines for Inpatient Facility, Outpatient Facility, and ASC Facility claims billed on the UB04 claim form.
• Able to manage and prioritize multiple priorities in a fast-paced work environment
• Experience in an analytic role collecting, querying, reporting, analyzing, and presenting data; preference in healthcare, accounting, or corporate finance setting
• Experience reading and applying coding guidelines to Institutional medical coding policies for Medicare, Medicaid, and Commercial insurers
• Strong knowledge of revenue cycle and business processes such as medical billing, collections, disputes, and denials
• Comprehension of Medicare and Medicaid claims editing rules not limited to DRGs, APC-DRGs, CCI, Fee Schedules, LCAs, and NCDs
• Minimum 2 years working in Payment Accuracy claims editing
• Bachelor's or healthcare professional degree preferred
• Ability to quickly learn business-specific software (e.g., project management, document creation)

Rialtic Values

• High Integrity
• Do the right thing. Provide candid feedback. Be humble and respectful.
• Be Bold & Accountable
• Prioritize the health and wellbeing of yourself and your teammates.
• Take Care of Yourself & Others
• Pursuit of Excellence
• Innovate, iterate and chase the best possible outcomes.
• Delivering value to our customers is our North Star.
• Work as One Team
• Speak up. Take accountability. Continually improve.
• Collaborative, inclusive environment to advance our mission.
• Customer Value Comes First

Rialtic Benefit Highlights:

• Unlimited PTO, comprehensive health plans and wellness reimbursements
• Meaningful equity and 401k matching
• Mental and physical wellness support through TalkSpace, Kindbody, Teladoc and One Medical subscriptions
• Comprehensive health plans with generous contributions to premiums
• Freedom to work from wherever you work best and a home office stipend to make it happen

We are headquartered in Atlanta, but we are remote-friendly. For this role, we are targeting candidates located in the Eastern or Central time zones only. This role must be performed in the USA.

Rialtic Values

• Be Bold & Accountable
• Delivering value to our customers is our North Star.
• Do the right thing. Provide candid feedback. Be humble and respectful.
• Speak up. Take accountability. Continually improve.
• Customer Value Comes First
• Take Care of Yourself & Others
• Prioritize the health and wellbeing of yourself and your teammates
• Innovate, iterate and chase the best possible outcomes.
• High Integrity
• Work as One Team
• Pursuit of Excellence
• Collaborative, inclusive environment to advance our mission.

Rialtic Benefits

• Comprehensive health plans with generous contribution to premiums
• Competitive compensation and meaningful equity
• Mental and physical wellness support through TalkSpace, Teladoc and One Medical subscription
• Freedom to work from wherever you work best and home office stipend to make it happen
• 401k with company matching
• Flexible PTO and wellness stipend

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 have built a total rewards philosophy that includes fair, equitable, competitive compensation that is performance and skillset based.

Our strategy is based on robust market research, including external advisory and salary sources specializing in national compensation, and thoughtful input from every level of our organization. It is a combination of a cash salary, equity, benefits, wellbeing, and opportunity.

Rialtic is an equal opportunity employer. All applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, or genetic information. We will not have access to your personal Equal Employment Opportunity Commission information during the interview process.

Rialtic is committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.

To request a reasonable accommodation, please let us know in your application or email us at

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TO ALL RECRUITMENT AGENCIES:

Rialtic does not accept agency resumes. Please do not forward resumes to Rialtic employees or any other company location. Rialtic is not responsible for any fees related to unsolicited resumes and will not pay fees to any third-party agency or company that does not have a signed agreement with the Company for this specific role.