This role is for an experienced healthcare claims and policy pro who can turn complex payer rules into clear, testable claim edit logic that prevents overpayments. You’ll research CMS, AMA/CPT, Medicaid/Medicare guidance and payer policies, then translate them into specifications, unit tests, and validation work that proves the edits function exactly as intended.
About Rialtic
Rialtic is an enterprise healthcare software company building payment accuracy products that help insurers and providers bring critical payment integrity work in-house. Founded in 2020 and backed by notable healthcare-focused investors, Rialtic focuses on reducing costs and improving efficiency and quality across payer and provider operations.
Schedule
- Atlanta or Remote (remote-friendly)
- Full time (schedule details not specified in posting)
What You’ll Do
- Review payer and regulatory guidance (Medicaid manuals, fee schedules, NCCI/CCI, OIG alerts, LCDs/LCDs, NCDs, Medicare manuals, etc.) and convert rules into claims editing logic
- Partner with concept creators to refine billing edits and ensure accuracy against policy intent
- Use data analysis to validate structure and outcomes align with policy and specs
- Build unit tests to verify edit functionality
- Produce research support using official source documents
- Validate edits via testing and defend decisions with validation data
- Stay current on key edit references (AMA, CMS, NCCI) and maintain/upkeep existing guidelines
- Collaborate with Content, Engineering, and Data teams to develop and tune edits
- Provide SME expertise on professional claims error areas across multiple specialties
- Meet weekly productivity and quality goals while working independently (including remote work)
What You Need
- 8+ years of healthcare experience with medical coding terminology
- Experience with a payer or claims editing vendor
- Payment accuracy experience (prepay or post-pay)
- Intermediate Excel skills (functions, pivot tables, VLOOKUP, etc.)
- Solid understanding of claims workflow and claim forms (CMS-1500 and UB-04)
- Experience reading/analyzing Medicare and Medicaid policy and applying coding guidelines
- Ability to update payment accuracy guidelines as policies change
- Strong cross-functional communication (Engineering/Product collaboration)
- Comfort learning tools like Google Workspace, Jira, SmartDraw, etc.
Benefits
- Remote flexibility plus home office stipend
- Equity and 401(k) matching
- Unlimited PTO
- Comprehensive health plans and wellness reimbursements
- Mental and physical wellness support (Talkspace, Teladoc, One Medical)
If you want to sit at the intersection of policy, coding, and building software logic that saves real dollars, this one’s in your lane.
Happy Hunting,
~Two Chicks…