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Full-Time

Healthcare Content Portfolio Analyst

Posted on 6/18/2024

Rialtic

Rialtic

51-200 employees

Cloud-based SaaS for healthcare payment accuracy

Data & Analytics

Mid

Remote in USA

Category
Healthcare Administration & Support
Physicians & Surgeons
Medical, Clinical & Veterinary
Required Skills
Communications
SQL
Excel/Numbers/Sheets
Requirements
  • 2-5+ years of claims editing experience with healthcare payers and/or claims editing software vendors
  • Nationally recognized coding or billing credential required: CCS, CCS-P, CPC, CPB
  • Billing, coding, revenue cycle, and claims editing software experience
  • Experience in claims adjudication and application of NCCI editing and multiple payment rules
  • Ability to interpret claim edit rules and references
  • Solid understanding of claims workflow including the interconnection with claim forms
  • Bonus: Intermediate level proficiency mapping CMS 1500, EDI and FHIR
  • Ability to apply industry coding guidelines to claim processes
  • Proven experience reviewing, analyzing, and researching coding issues for payment integrity
  • Logics skills: ability to break policy edits down into decision-making paths
  • Ability to troubleshoot and apply root-cause analysis of logics not functioning as intended
  • Computer skills: ability to use Google Workspace, Amazon Workspace, Jira, SmartDraw, and other software with minimal training
  • Intermediate level proficiency in Excel (ability to manipulate data using Excel functions along with pivot tables, v-lookup, etc.)
  • Excellent verbal & written communication skills
  • Bonus: SQL query-building and lookup skills
Responsibilities
  • Review healthcare policy for coding and billing guidelines that can be turned into software editing rules
  • Create billing edits that provide clients with monetary savings and promote coding accuracy
  • Use structural design to turn policy language into specifications for developers
  • 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 if edits are working as intended and support decisions with validation data
  • Maintain current industry knowledge of claim edit references including AMA, CMS, NCCI
  • Collaborate with Content and Engineering & Data teams to develop, adjust, and validate edits
  • Provide subject matter expertise on professional claims top error areas in coding and billing across multiple specialties
  • Independently meet weekly productivity and quality goals
  • Be a self-starter and remain driven while independently working remotely (hybrid in Atlanta preferred)

Rialtic, a next-generation healthcare platform, enhances provider collaboration and streamlines operations in the healthcare sector through its advanced cloud-based SaaS technology. This focus on payment accuracy not only reduces administrative burdens but also contains medical costs, promoting efficiency for healthcare payers and providers. The company offers a supportive work environment where technology and healthcare expertise converge, making it a premier workplace for professionals passionate about transforming healthcare operations and improving system efficiency.

Company Stage

Series B

Total Funding

$79.7M

Headquarters

Atlanta, Georgia

Founded

2020

Growth & Insights
Headcount

6 month growth

-1%

1 year growth

-3%

2 year growth

-9%
INACTIVE