Medical Content Analyst, Specialist – Pre-Pay Policy

Role Overview

• 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).