Medical Content Analyst

Lyric, formerly ClaimsXten, is a leading healthcare technology company, committed to simplifying the business of care. Over 30 years of experience, dedicated teams, and top technology help deliver more than $14 billion of annual savings to our many loyal and valued customers—including 9 of the top 10 payers across the country. Lyric's solutions leverage the power of machine learning, AI, and predictive analytics to empower health plan payers with pathways to increased accuracy and efficiency, while maximizing value and savings. Lyric's strong relationships as a trusted ally to customers resulted in recognition from KLAS as "true partner" and "excellent value for investment," with a top score for overall customer satisfaction and A+ likelihood to recommend in their October 2023 Payment Integrity and Accuracy Report. Discover more at  

JOB SUMMARY

The Medical Content Analyst will independently research and identify new clinical content areas of claims editing, by reviewing specialty societies, peer reviewed medical journals, etc., to recommend new savings opportunities for Lyric customers.

ESSENTIAL JOB RESPONSIBILITIES & KEY PERFORMANCE OUTCOMES

• Evaluate analytics reports and medical claims to identify new claims editing opportunities
• Contribute to the content topics backlog for editing consideration
• Function as a subject matter expert for current claims audition and medical coding scenarios to expand editing outcomes
• Provide content knowledge transfer to colleagues for rule development
• Solve problems related to the interpretation of inpatient coding or ICD-10-CM coding conventions/guidelines for inclusion or exclusion with Lyric business rules
• Responsible for making recommendations within the software for the denial of diagnosis, age, or other criteria on medical claims based on coding guidelines

REQUIRED SKILLS & EXPERIENCE

Required:

• BS Nursing, BS Pharmacy or equivalent required
• 4 years' experience in medical billing, coding, claims processing, bill and/or chart review/auditing, is required. Previous experience working with US health insurance payers in a claims, appeals or coding capacity is also required
• Experience in denial management or claim review management is a plus
• Excellent communication skills (verbal and written) enabling effective communication both internally with all areas of the business and externally
• Demonstrated proficiency with various software applications, including but not limited to: MS Word; MS Excel; MS Access; Visio; JIRA; SharePoint with MS project a plus
• AHIMA Certified Coding Specialist – Physician (CCS-P) or AAPC Certified Professional Coder (CPC) is required

GENERAL COMPETENCIES

Required:

• Ability to influence and direct thoughts and actions to successfully reach goals
• Embraces challenges, persists in the face of setbacks and finds inspiration in the success of others
• Proven ability to engender client trust and build relationships through partnering with clients for innovation and providing high quality products and services
• Can provide clear, balanced advice/counsel on a range of strategic and complex management, product and market issues
• Results-oriented style with a high degree of analytical ability and proven problem-solving skills
• Ability to thrive and quickly adapt to change, leading others through change in a dynamic, fast-paced industry and work environment
• Ability to manage a team in a matrix environment to recruit and retain top talent, build consensus, and rally members to achieve results
• Effectively builds strong relationships and partnerships within and outside of the company. Able to effectively navigate within a matrixed corporate structure
• With an open, honest and direct communication style that establishes an empathetic and effective relationship

Lyric is an Equal Opportunity Employer that drives superior business results by understanding and leveraging diversity. We strive to maximize the productivity and performance of our employees by fostering a winning team spirit and high personal accountability. Everyone is encouraged to respond including women, people of color, veterans, people with disabilities, all lifestyles, beliefs and generational diversity.