Rialtic · 21 hours ago
Research Consultant
United States
Full-time
Remote
Mid Level
4+ years expRialtic is transforming how health insurers and providers manage payment accuracy through its enterprise SaaS platform. The Research Consultant role involves interpreting complex healthcare policies into automated logic, collaborating with cross-functional teams, and providing expertise in coding and billing to enhance payment accuracy.
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
Act as a subject matter expert across Medicaid, Medicare, and commercial lines—providing deep expertise in coding, billing, and reimbursement
Collaborate cross-functionally with Product and Engineering to improve tooling, streamline development workflows, and enhance overall content delivery
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
Provide payment policy and medical coding expertise to help create and maintain claim edits, including recommendations for configuration criteria for edit sustainability
Assist with research to identify opportunities for new policies, including performing medical coding analysis
Work across the Content team to provide medical coding expertise to resolve customer inquiries regarding claim edit application
Assist in creating and maintaining documentation for Rialtic’s policy content library
Collaborate cross-functionally with Product and Engineering to identify automation opportunities, improve tooling, streamline development workflows, and enhance overall content delivery
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
Required
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)
Preferred
Bachelor's degree preferred in Healthcare, Technology, or a related field
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
Benefits
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
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