Medical Content Analyst, Specialist (Pre-Pay Policy)

About the role

Lyric is an AI-first, platform-based healthcare technology company focused on simplifying the business of care through accurate pre-payments and reducing healthcare waste. As a market leader with 35 years of pre-pay editing expertise, Lyric is recognized for its commitment to innovation and excellence.

Responsibilities

• Advises on ClaimsXten clinical content and rules/policies, including documentation requirements, client customizations, and configuration options.
• Serves as a subject matter expert on ClaimsXten edit logic, content sourcing, rationale, and expected outcomes, explaining these to organizations utilizing Lyric’s edits for pre-payment editing.
• Maintains a working understanding of Lyric’s product behavior to explain and troubleshoot edit outcomes such as triggers, rule logic, content overlaps, and configuration dependencies.
• Reviews data analytics to assess impacts of content changes and new CPT/HCPCS/ICD10CM code set updates.
• Serves as a Clinical liaison across Clinical Operations, Client Success, and other cross-functional Lyric teams to enhance the value of ClaimsXten edits for clients.
• Supports client escalations related to Pre-Payment edits, analyzing scenarios and recommending resolution paths.

Requirements

• Bachelor’s degree in health information management, nursing, or other healthcare-related field.
• 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 in 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.

Preferred Qualifications

• Master’s degree in business or healthcare-related field.
• Previous experience as a medical coder.
• Previous experience at a Health Insurance plan.
• Extensive knowledge of pre-payment editing, payment policies, and payment integrity.
• 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.
• Takes initiative and works independently with minimal direction.
• Strong communication skills, especially in presenting complex material via all mediums.
• Expert-level analytical skills, able to identify trends and assess potential vulnerabilities.
• Superior critical thinking skills.
• Proficiency in Microsoft applications.

Pay

The US base salary range for this full-time position is: $125,241.00 - $187,862.00. The specific salary offered to a candidate may be influenced by a variety of factors including but not limited to the candidate’s relevant experience, education, and work location.