Healthcare Accuracy Specialist

Atlanta or Remote

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 product brings programs in-house and helps health insurance companies gain total control over processes that disparate and misaligned vendors have managed.

Currently working with leading healthcare insurers and providers, we are tackling a $1 trillion problem to reduce costs, increase efficiency and improve quality of care.

For more information, please visit (Use the "Apply for this Job" box below)..

As a Healthcare Content Analyst you’ll research and interpret CMS, CPT/AMA, and other major payer policies in accordance with healthcare coding and regulatory requirements. You’ll identify common error areas that can be turned into automated software logic that prevents over payments. Your edits will move from concept to specification, then through review, testing, and data validation, collaborating with the smartest minds in healthcare policy and technology.

Your goal every day is to develop claims editing logic that promotes payment accuracy and transparency across Medicaid, Medicare, and commercial lines of business, increasing your revenue‑cycle acumen while turning policy excerpts into educational rules for payers and providers.

• 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 to provide billing edits that deliver client savings and coding accuracy, ensuring accuracy and offering feedback.
• Ensure the structural design follows policy intent through 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 that edits work as intended and support decisions with validation data.
• Maintain current industry knowledge of claim edit references, including AMA, CMS, NCCI.
• Collaborate with the Content, Engineering, and Data teams to develop, adjust, and validate edits.
• Provide subject‑matter expertise on top coding and billing error areas across multiple specialties.
• Independently meet weekly productivity and quality goals.
• Be self‑starter and stay driven while working remotely.

• 8+ years of professional experience in Healthcare, familiar with medical coding terminology.
• Experience working for a payer or editing vendor.
• Payment accuracy experience with pre‑payment or post‑payment knowledge.
• Intermediate proficiency in Excel (functions, pivot tables, VLOOKUP, etc.).
• Solid understanding of claims workflow, including interconnection with claim forms (CMS 1500 & UB-04).
• Experience reading and analyzing Medicare/Medicaid data and policy, including fee schedules, CCI, OIG Alerts, LCAs/LCDs, NCDs.
• Experience applying industry coding guidelines to claim processes.
• Experience 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, Smart Draw and other software with minimal guidance.

• Nationally recognized coding or billing credentials: CPC, CCS-P, RHIA, CCS, CPB.
• SQL query‑building and lookup skills for claims data analysis and data mining for editing opportunities.
• Claims editing experience.
• Experience with mapping CMS 1500, EDI and FHIR.
• Bachelor’s Degree (preferred in Healthcare, Technology, or a related field).

• High Integrity – Do the right thing. Provide candid feedback. Be humble and respectful.
• Customer Value Comes First – Delivering…