Content Analyst II/III – Validation
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 Validation Content Analyst, you'll research, test, and validate Rialtic's Policy Library, which powers healthcare medical claims edits for payers. Daily, you'll read Institutional and Professional coding policy source documents from Medicare and Medicaid to build test-case scenarios and perform quality assurance on the structure our technology relies on.
You'll take edits from concept to specification and then through review, testing, and data validation — collaborating with a cross-functional team of medical coders, clinicians, and payment accuracy experts along the way. This is an exciting opportunity to grow your technical skills while deepening your healthcare and revenue-cycle expertise in a modern SaaS environment.
WHAT YOU'LL DO
• Review healthcare policy (Medicaid manuals, fee schedules, CCI, OIG Alerts, LCAs/LCDs, NCDs, Medicare manuals, etc.) for coding and billing guidelines, and use data validation to confirm the policy and specs align.
• Work with the concept creation team that builds billing edits, providing feedback and quality checks on their edits.
• Ensure structural design follows policy intent by using data analysis.
• Build unit tests to verify the functionality of 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 documentation. • Validate that edits are working as intended and support decisions with validation data. • Maintain current industry knowledge of claim edit references, including AMA, CMS, and NCCI. • Collaborate with the Content and Engineering & Data teams to develop, adjust, and validate edits.
• Provide subject matter expertise on top professional claims error areas in coding and billing across multiple specialties.
- Independently meet weekly productivity and quality goals as a self-starter working remotely.
WHAT YOU BRING
• 4+ years of professional experience in healthcare, with familiarity in medical coding terminology and claims. • Experience working for a payer or editing vendor.
• Payment accuracy experience with prepayment or post-payment knowledge.
• Proficient computer skills, with the ability to self-learn Google Workspace, Amazon Workspace, Jira, and other software with minimal guidance.
• Strong collaboration skills, with the ability to communicate across departments such as Engineering and Product.
NICE TO HAVES
• Nationally recognized coding or billing credentials: CPC, CCS-P, RHIA, CCS, CPB.
• SQL query-building and lookup skills for claims data analysis and identifying editing opportunities, including experience reading and analyzing Medicare/Medicaid data and policy (fee schedules, CCI, OIG Alerts, LCAs/LCDs, NCDs).
• Experience reading Medicare/Medicaid policies and applying industry coding guidelines to claims processes.
• Experience reading updated policy (e.g., CPT, Medicare, Medicaid) and updating existing payment accuracy guidelines (Maintenance).
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.