Medical Content Analyst, Specialist – Pre-Pay Policy

🔥 0 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $125.2k - $187.9k / year

⏰ Full Time

🟠 Senior

🔴 Lead

✍️ Content Marketing Manager

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Lyric - Clarity in motion.

WebsiteLinkedInAll Job Openings

201 - 500 employees

⚕️ Healthcare Insurance

💳 Fintech

☁️ SaaS

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.

📋 Description

• Advises on ClaimsXten clinical content and rules/policies, including documentation requirements, client customizations, and configuration options. • Leads client-facing discussions, serving as subject matter expert explaining ClaimsXten edit logic, content sourcing, rationale and expected outcomes to organizations that utilize Lyric’s edits for pre-payment editing. • Maintains working understanding of Lyric’s product behavior to explain and troubleshoot edit outcomes (e.g., triggers, rule logic, content overlaps, configuration dependencies). • Reviews data analytics to assess impacts to content changes and new CPT/HCPCS/ICD10CM code set updates. • Supports client escalations related to Pre-Payment edits, including analysis of scenarios and articulation of recommended resolution paths. • Serves as Clinical liaison across Clinical Operations, Client Success, and other cross functional Lyric teams to increase value of ClaimsXten edits to clients.

🎯 Requirements

• Bachelor’s degree in health information management, Nursing or other Healthcare related degree. • American Academy of Professional Coders (AAPC) Certified Professional Coders (CPC) certification or American Health Information Management Association (AHIMA) Certified Coding Specialist-Physician (CCS-P) or Certified Coding Specialist (CCS). • Minimum of twelve (12) years relevant healthcare experience, with at least three (3) years health insurance payer experience as a payment/reimbursement or medical policy analyst, medical claims processor, chart reviewer/auditor, or clinical editing analyst. • Minimum of three (3) years experience with ClaimsXten. • Master’s degree in business or healthcare related field (preferred). • Previous experience as a medical coder (preferred). • Previous experience at a Health Insurance plan (preferred). • Strong knowledge of pre-payment editing, payment policies and payment integrity (preferred). • Extensive demonstrated understanding of US health insurance payers including Commercial, Medicare, Medicaid (FFS and MCOs), third-party claims processing (including paper & EDI processes), medical coding, and medical billing (preferred). • Takes initiative and works independently with minimal direction (preferred). • Strong communication skills including expert level at presenting extraordinarily complex material via all mediums (preferred). • Possess the ability to analyze complex data, identify trends and assess potential vulnerabilities (preferred). • Superior critical thinking skills (preferred). • Proficiency in Microsoft applications (preferred).