Payment Integrity Analyst – Post Pay

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October 3

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Lyric - Clarity in motion.

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Healthcare Insurance • Fintech • SaaS

Lyric is a leading healthcare technology company focused on payment integrity and accuracy solutions. With over 30 years of experience, Lyric aims to simplify the business of care by leveraging machine learning and predictive analytics to empower health plan payers. The company provides a range of solutions, including Lyric 42 Platform, Pre-Pay Editing, Diagnostics Module, Coordination of Benefits, Concept Libraries, and LyricIQ, which combines AI-powered payment accuracy services. Additionally, Lyric focuses on transparency and responsibility in technology development, ensuring enhanced payment accuracy, administrative efficiencies, and reduced provider abrasion. As a trusted partner in the healthcare industry, Lyric continues to deliver cutting-edge technologies at the crossroads of healthcare and fintech, supporting health plans and providers in the shift to value-based care.

201 - 500 employees

⚕️ Healthcare Insurance

💳 Fintech

☁️ SaaS

📋 Description

• Research new customer specific value opportunities; create SQL queries, analyze data; size opportunity and present potential value back to leaderships (40%) • Improve existing models by analyzing model performance against benchmarking, identifying gaps and providing recommendations. (10%) • Identify opportunities for further automation of repetitive tasks. (10%) • Support the payment integrity team in a variety of business processes including but not limited to processing medical insurance claim overpayments through recovery (40%) • Review claims for missing or incomplete information, calculate payment, or validation of identified overpayments. • Reconcile submission response files, work with key stakeholders to resolve issues and ensure outstanding response pipeline is current. • Process overpayments (provider refunds) requests, support notification letters process. • Recognize and document system issues. • Keep abreast of the changes in regulations, program policies and current processing procedures. • Ensure legal compliance by following company policies, client policies, procedures, guidelines, as well as state and federal regulations. • Collaborate with clients to resolve provider disputes and inquiries • Maintain productivity goals and standards set by the department • Process overpayments (provider refunds, adjustments, offsets) request

🎯 Requirements

• 1+ years of SQL programming/queries, as well as advanced excel experience • 1+ Years’ experience auditing medical claims to identify improper payments as a Payment Integrity Vendor or within a Health Plan’s Payment Integrity team. • 1+ years of experience performing data analytics with large data sets • Preferred Qualifications: Bachelors degree in business or healthcare/related field • 1+ years of experience with automation tools (e.g. UIPath) • 1+ years of combined experience in healthcare, such as prior work in health insurance, claims processing or adjudication, or fraud, waste and abuse detection • 1+ years of experience in medical billing codes including but not limited to CPT, ICD-10-PCS, ICD-10-CM, HCPCS, and NDC, as well as an understanding of medical terminology, and prospective payment systems including DRG, OPPS, and MIPS