Healthcare Payment Integrity Analyst

Payment Integrity Rialtic is transforming how health insurers and providers manage payment accuracy. As an enterprise SaaS platform, we empower organizations to take full control of critical business functions—reducing cost, increasing efficiency, and improving care quality. Backed by top investors including Oak HC/FT, F-Prime Capital, Health Velocity Capital, and Noro-Moseley Partners, we're solving a $1 trillion problem by replacing fragmented vendor solutions with a modern, data-driven platform. Learn more at www.rialtic.io. The Role As a Healthcare Content Analyst, you'll transform complex healthcare policy into intelligent, automated logic that powers Rialtic's payment accuracy engine. Working at the intersection of clinical expertise, policy research, and SaaS development, you'll create high-impact claims editing rules that help leading payers reduce overpayments and promote transparent, accurate reimbursement practices. This is a high-autonomy, high-impact role for someone who thrives in a collaborative, cross-functional environment and is eager to deepen their technical expertise while shaping a modern healthcare platform. What You'll Do • 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. What You Bring 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) Nice to Haves SQL skills for data validation or edit opportunity analysis Experience mapping EDI, CMS 1500 or FHIR formats Project management experience in a SaaS or healthcare setting Why Join Us At Rialtic, you'll be part of a team that's bold, mission-driven, and values-centered. We work as one team, prioritize customer value, and strive for excellence, —while taking care of ourselves and each other. We offer: • 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 Not Sure if You Meet Every Qualification? Studies show that women and people of color are less likely to apply unless they meet all criteria.At Rialtic, we believe diverse teams create better outcomes. If you're excited about this role—even if your background doesn't align perfectly—we encourage you to apply. You might be just the right fit. Apply tot his job