Associate Claims Validation Analyst

📋 Description

• Interpret CMS, AMA/CPT, and payer policies into claims editing logic.
• Use data-driven insights to identify new policy opportunities.
• Serve as SME across Medicaid, Medicare, and commercial coding and reimbursement.
• Collaborate with Product and Engineering to improve tooling and content delivery.
• Stay current on health regulations to keep Rialtic’s logic compliant.
• Overachieve productivity and quality targets in a remote, outcomes-driven environment.

🎯 Requirements

• Bachelor’s degree preferred in Healthcare, Technology, or related field.
• 4+ years of experience in healthcare coding, billing, or payment accuracy.
• National coding credential: CPC, CCS-P, RHIA, CCS, CPB or equivalent.
• Deep familiarity with CMS policies (LCAs, LCDs, NCDs), CCI edits, OIG alerts, fee schedules.
• Strong understanding of claims processing workflows (CMS-1500, UB-04).
• Prior experience developing or managing claims edits in a pre- or post-pay context.

🎁 Benefits

• Remote-first flexibility and home office stipend
• Meaningful equity and 401(k) match
• Open and Flexible PTO plan, comprehensive medical/dental/vision plans
• Wellness reimbursements and access to TalkSpace, Teladoc, and One Medical