Rialtic · 6 hours ago
Payment Integrity Analyst
United States
Full-time
Remote
Senior Level, Lead/Staff
8+ years expRialtic is an enterprise software platform empowering health insurers and healthcare providers to run their most critical business functions. The Payment Integrity Analyst will research and interpret healthcare policies, develop claims editing logics, and collaborate with teams to promote payment accuracy and transparency across various lines of business.
Enterprise SoftwareHealth CarePayments
Responsibilities
Review healthcare policy (Medicaid manuals, fee schedules, CCI, OIG Alerts, LCAs/LCDs, NCDs, Medicare manuals, etc.) for coding and billing guidelines that you will interpret and use data validation to ensure the policy and specs align
Work with the concept creation team who create billing edits that provide clients with monetary savings and promote coding accuracy, to ensure accuracy and provide feedback on their edits
Ensure that the structural design follows the policy intent by using data analysis
Build unit tests to verify the functionality of the edits
Apply revenue cycle, coding, and billing expertise to interpret policy based on correct coding, billing, and auditing guidelines
Provide in-depth research on regulations and support edits with official documents
Validate if edits are working as intended and support decisions with validation data
Maintain current industry knowledge of claim edit references including, but not limited to: AMA, CMS, NCCI
Collaborate with the Content and Engineering & Data teams to develop, adjust, and validate edits
Provide subject matter expertise on several professional claims top error areas in coding and billing across multiple specialties
Independently meet weekly productivity and quality goals
Be a self-starter and remain driven while independently working remotely
Qualification
Required
Bachelor's Degree preferred in Healthcare, Technology, or experience in a related field
8+ years of professional experience in Healthcare, familiar with medical coding terminology
Experience working for a payer or editing vendor
Payment accuracy experience with prepayment or post-payment knowledge
Intermediate level proficiency in Excel (ability to manipulate data using excel functions along with pivot tables, VLOOKUP, etc)
Solid understanding of claims workflow, including the interconnection with claim forms (CMS 1500 & UB-04)
Experience 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)
Collaboration Skills: Ability to communicate & collaborate with different departments such as Engineering & Product teams
Proficient Computer skills: Ability to self-learn Google Workspace, Amazon Workspace, Jira, SmartDraw and other software with minimal guidance
Preferred
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 opportunities
Claims editing experience
Project Management experience
Experience with mapping CMS 1500, EDI and FHIR
Benefits
Freedom to work from wherever you work best and a home office stipend to make it happen
Meaningful equity and 401 (k) matching
Flexible PTO Plan
Wellness Stipend
Comprehensive health plans with generous contributions to premiums
Mental and physical wellness support through TalkSpace, Teladoc and One Medical subscriptions
Company
Rialtic
Rialtic operates an open marketplace enterprise platform designed to equip and assist payers to make accurate healthcare payments.
51-200 employees
Funding
Current Stage
Growth StageTotal Funding
$79.71MKey Investors
F-PrimeOak HC/FT
2023-08-04Series Unknown· $36.71M
2022-03-02Series A· $28M
2020-10-22Series A· $15M
Leadership Team
J. Douglas Williams
Founder
Roy Ziegler
Advisory Board
Recent News
2024-04-13
Payments Dive
2024-01-20
The Business Journals
2023-12-22
Company data provided by crunchbase