Research Content Analyst
Payment Integrity | Rialtic, Inc.
ABOUT RIALTIC
Rialtic is an enterprise software platform empowering health insurers and healthcare providers to run their most critical business functions. Founded in 2020 and backed by leading investors including Oak HC/FT, F-Prime Capital, Health Velocity Capital, and Noro-Moseley Partners, Rialtic's best-in-class payment accuracy platform brings programs in-house and helps healthcare organizations gain full control over processes traditionally managed by fragmented vendors. Today, we partner with leading healthcare insurers and providers to tackle a $1 trillion problem — reducing costs, increasing efficiency, and improving quality of care. Learn more at www.rialtic.io. THE ROLE
As a Research 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 recommend new policy opportunities.
• Act as a subject matter expert across Medicaid, Medicare, and commercial lines — providing deep expertise in coding, billing, and reimbursement.
• Provide payment policy and medical coding expertise to help create and maintain claim edits, including recommendations for configuration criteria that support 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 that resolves 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.
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, and 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 YOU'LL LOVE IT HERE
At Rialtic, you'll be part of a team that's bold, mission-driven, and values-centered:
• High Integrity: Do the right thing. Be candid, humble, and respectful.
• Customer Value Comes First: Our customers are our North Star.
• Work as One Team: Collaboration and inclusion drive better outcomes.
• Be Bold & Accountable: Speak up, take ownership, and keep improving.
• Pursuit of Excellence: Innovate, iterate, and raise the bar.
• Take Care of Yourself & Others: Wellbeing matters — for everyone.
We offer remote-first flexibility with a home office stipend, meaningful equity and 401(k) match, an open and flexible PTO plan, comprehensive medical/dental/vision plans, and wellness reimbursements including access to TalkSpace, Teladoc, and One Medical.
DON'T MEET EVERY QUALIFICATION?
Studies show that women and people of color are less likely to apply to jobs unless they meet every qualification listed. At Rialtic, we're building a diverse, inclusive, and authentic workplace — if you're excited about this role but your experience doesn't align perfectly with every qualification, we encourage you to apply anyway. You may be just the right candidate for this or another role.