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Rialtic · 2 days ago

Healthcare Payment Integrity Analyst

United States

Full-time

Remote

Mid Level

4+ years exp

Rialtic is transforming how health insurers and providers manage payment accuracy through its enterprise SaaS platform. The Healthcare Payment Integrity Analyst will interpret complex healthcare policies into automated logic for claims editing, ensuring payment accuracy and collaborating with various teams to enhance the healthcare platform.

Enterprise SoftwareHealth CarePayments

Responsibilities

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

Qualification

Healthcare codingPayment accuracyCMS policiesClaims processing workflowsNational coding credentialExcel skillsSQL skillsCollaborationProject management