Senior Manager, Clinical Content Maintenance

Job not on LinkedIn

November 5

Apply Now

Receive Emails with Similar Jobs

Lyric - Clarity in motion.

WebsiteLinkedInAll Job Openings

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

• Mentor and development Medical Content Analysts to achieve departmental KPIs • Serve as subject matter expert on CPT, HCPCS, ICD10CM coding and claims edit logic (including NCCI, LCDs, State Medicaid, MUEs, Lyric edits and payer medical policies) • Provide consultative support to internal and external clients by explaining clinical content development standard operating procedures for automated edits • Contribute constructive feedback to the creation of Lyric’s claims editing concepts • Translate complex coding and billing concepts into clear, actionable guidance for diverse client audiences (Medical Directors, Policy Leads, etc.) • Stay current on regulatory trends, major CPT/ICD10CM guideline changes as well as other pertinent updates to advise clients on their implications

🎯 Requirements

• Bachelor’s degree in healthcare administration, Nursing, Health Information or other healthcare related degrees • 8+ years relevant experience, with at least 3 years of experience in a health insurance payer or automated claims editing solution, as a payment, reimbursement or medical policy analyst, medical claims processor, chart auditor/reviewer, or claims edit/denial management • 3+ years of experience managing coding, billing or claims processing professionals • Active AAPC Certified Professional Coders (CPC) certification or American Health Information Management Association (AHIMA) Certified Coding Specialist-Physician (CCS-P) • Working knowledge of pre-payment editing and payment integrity • Extensive demonstrated understanding of US health insurance payers including Commercial, Medicare, Medicaid (FFS and MCOs), third-party claims processing (including paper & EDI processes), and payment/reimbursement methodologies • Proficiency in Microsoft applications • Proficiency in appropriate use of Artificial Intelligence applications