Drug and Biological Clinical content Analyst

Drug and Biological Clinical Content Analyst Payment Integrity | Rialtic, Inc. ABOUT RIALTIC 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 platform brings programs in-house and helps healthcare organizations gain full control over processes traditionally managed by fragmented vendors. Today, we partner with leading healthcare insurers and providers to tackle a $1 trillion problem — reducing costs, increasing efficiency, and improving quality of care. Learn more at www.rialtic.io. THE ROLE As a Drug and Biological Clinical Content Analyst, you will maintain and enhance the intelligent, automated logic that powers Rialtic's drug and biological payment accuracy platform. You'll ensure existing claims-editing logic remains current, compliant, and aligned with evolving drug policy across FDA labeling, off-label compendia approved indications, and literature-supported utilization. This role sits at the intersection of pharmaceutical expertise, policy research, and SaaS delivery. It's a great fit for someone who enjoys deep policy work, values quality and consistency, and is excited to grow technical skills in a modern healthcare technology environment. WHAT YOU'LL DO • Maintain and enhance existing edits by managing the full lifecycle — from research and specification through testing, validation, and deployment. • Review, interpret, and create updates from clinical literature and journal articles related to the off-label use of drugs. • Monitor and make policy changes in accordance with FDA labels, compendia drug sources, and payer policies. • Validate that edits perform as intended using data analysis and unit testing. • Serve as a subject matter expert in coding, billing, and reimbursement across professional and institutional claims. • Collaborate closely with Product, Engineering, and Data teams to improve tooling, workflows, and content quality. • Stay current on evolving healthcare regulations, coding standards, and industry guidance. • Consistently meet productivity and quality targets in a remote, outcomes-driven environment. WHAT YOU BRING • Degree in Pharmacy, Healthcare, or a related field (or equivalent experience). • 4+ years of experience in healthcare coding, billing, payment integrity, or related roles. • National coding or billing credentials (CPC, CCS-P, RHIA, CCS, CPB). • Strong knowledge of CMS policy (NCDs, LCDs/LCAs), clinical trial design, and clinical literature research. • Experience working with claims workflows and forms (CMS-1500, UB-04). • Prior experience maintaining or updating claims edits in pre-pay or post-pay environments. • Comfort collaborating cross-functionally in a tech-forward, SaaS environment. •…