You will be responsible for:

The Facility Edits Claims Analyst will report directly to the Director of Content at Rialtic. You will be responsible for designing, validating, and maintaining our Policy Library which provides healthcare medical claims edits for payers. On a daily basis, you will read Institutional and Professional coding policy source documents from Medicare and Medicaid to create the design structure our technology relies on.

You will be challenged to find new ways to mine data and identify new opportunities for source-based rules while maintaining Policies for our Payment Accuracy Library. Collaborating with content managers, the medical director, and engineers will be the norm.

In addition, you will:

• Work closely with a team of experts with extensive medical claims experience
• Understand and apply medical coding guidelines to institutional and professional source documents not limited to Medicare, Medicaid, and Commercial insurers
• Translate the documents' coding guidelines into a structured design that engineers develop into software - medical claims edits
• Analyze policies and claims database to identify patterns of inaccurate payment accuracy and opportunities for creating new source document-based rules
• Enter design details into content management software including data entry, downloading, and attaching source documents
• Research, build analyze, and test edits to be used in the Claims Editing library
• Utilize strong coding and industry knowledge to research regulatory updates, create and maintain editing content (data used by the edits)
• Ensure adherence to quality assurance guidelines
• Serve as a subject matter expert for content and edits and provide support where needed
• Test and validate changes made to the content

Required Qualifications

• Bachelor's or healthcare professional degree preferred
• Minimum 2 years working in Payment Accuracy claims editing
• Strong knowledge of revenue cycle and business processes such as medical billing, collections, disputes, and denials
• Experience in an analytic role collecting, querying, reporting, analyzing, and presenting data; preference in healthcare, accounting, or corporate finance setting
• Able to manage and prioritize multiple priorities in a fast-paced work environment
• Exceptional analytical and problem-solving skills; able to analyze processes and information, identify problems and trends
• Strong attention to detail and follow-up skills/strong interpersonal skills; ability to relate with different personalities

• Comfortability using Jira, Google Apps (Google Docs, Google Sheets), Notion, Slack, and Content management software.
• Knowledge of institutional medical coding and billing guidelines for Inpatient Facility, Outpatient Facility, and ASC Facility claims billed on the UB04 claim form.
• Current certified coder (CCS, CIC, COC, CASCC, and/or CPC)
• Comprehension of Medicare and Medicaid claims editing rules not limited to DRGs, APC-DRGs, CCI, Fee Schedules, LCAs, and NCDs
• Experience reading and applying coding guidelines to Institutional medical coding policies for Medicare, Medicaid, and Commercial insurers
• Participation in turning medical coding policies into structured design for software development
• Ability to quickly learn business-specific software (e.g., project management, document creation)

Rialtic Values

• High Integrity
• Do the right thing. Provide candid feedback. Be humble and respectful.
• Customer Value Comes First
• Delivering value to our customers is our North Star.
• Work as One Team
• Collaborative, inclusive environment to advance our mission.
• Be Bold & Accountable
• Speak up. Take accountability. Continually improve.
• Pursuit of Excellence
• Innovate, iterate and chase the best possible outcomes.
• Take Care of Yourself & Others
• Prioritize the health and wellbeing of yourself and your teammates.

Rialtic Benefit Highlights:

• Freedom to work from wherever you work best and a home office stipend to make it happen
• Meaningful equity and 401k matching
• Unlimited PTO, comprehensive health plans and wellness reimbursements
• Comprehensive health plans with generous contributions to premiums
• Mental and physical wellness support through TalkSpace, Kindbody, Teladoc and One Medical subscriptions

We are headquartered in Atlanta, but we are remote-friendly. For this role, we are targeting candidates located in the Eastern or Central time zones only. This role must be performed in the USA.

Rialtic Values

• High Integrity
  • Do the right thing. Provide candid feedback. Be humble and respectful.
• Customer Value Comes First
  • Delivering value to our customers is our North Star.
• Work as One Team
  • Collaborative, inclusive environment to advance our mission.
• Be Bold & Accountable
  • Speak up. Take accountability. Continually improve.
• Pursuit of Excellence
  • Innovate, iterate and chase the best possible outcomes.
• Take Care of Yourself & Others
  • Prioritize the health and wellbeing of yourself and your teammates

Rialtic Benefits

• Freedom to work from wherever you work best and home office stipend to make it happen
• Competitive compensation and meaningful equity
• 401k with company matching
• Flexible PTO and wellness stipend
• Comprehensive health plans with generous contribution to premiums
• Mental and physical wellness support through TalkSpace, Teladoc and One Medical subscription