Payment Integrity Consultant

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November 1

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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

• Recommend new proposals for pre-payment claim edits to provide clients with incremental savings. • Analyze paid claims data for the purpose of identifying overpayments and areas for incremental savings. • Ability to provide detailed requirements to the development team to build proposals recommended by consultant. • Function as a Consultant to internal and external clients to introduce new concepts, estimate realistic savings, and evangelize value to ensure client adoption. • Stay abreast of all topics relevant to coding/billing/overpayment trends, changes in coding guidelines and industry standards. • Prepare, deliver, and provide clinical support related to clinical content to both internal and external customers. • Serve as clinical content SME on cross-functional teams, to communicate relevant client or industry feedback to project stakeholders for product revisions and/or new functionality.

🎯 Requirements

• Bachelor’s degree in healthcare information system management, Health Information Management, Nursing, or other Healthcare related degree preferred • American Academy of Professional Coders (AAPC) Certified Professional Coders (CPC) certification or American Health Information Management Association (AHIMA) Certified Coding Specialist-Physician (CCS-P) is required prior to hire date. • 5 years or more relevant healthcare experience as a medical coder, medical claims processor medical auditor, clinical editing analyst, or payment or medical policy analyst. • Master’s degree in business or healthcare related field preferred. • Previous experience in physician or centralized billing office with multi-specialty practices preferred. • Previous experience as a nurse is a plus. • Current working knowledge of pre-payment editing and payment integrity. • Possess expertise at communication and presenting extraordinarily complex material via all mediums. • Must be initiative-taking and self-directed. • Mastery of analyzing complex data analytics, identification of trends and assessment of potential overpayment vulnerabilities. • Superior critical thinking skills • Knowledge of healthcare reimbursement and medical policies as well as payment methodologies. • Ability to work independently, with minimal supervision. • Proficiency in Microsoft applications.