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 Lyric.ai.

The Medical Content Staff team member is integral to the success of the content development process at Lyric. The team member serves as subject matter expert on clinical content and editing topics. This role is vital to the expansion and effectiveness of our claims editing packages and helps ensure payment accuracy.

ESSENTIAL JOB RESPONSIBILITIES & KEY PERFORMANCE OUTCOMES

• Independently identify new claim edits to increase client offerings by leading analysis of Medicare, Medicaid, Specialty Society, and other correct coding authored publications
• Analyze complex client analytical data to identify aberrant medical billing trends and provide incremental new client offerings.
• Collaborate with cross-functional teams to support business needs of Lyric clients.
• Author client facing documentation to support implementation of incremental edits
• Perform competitive analysis to enhance existing Lyric solutions.
• Act as a subject matter expert regarding medical billing, coding and claims editing outcomes to internal and external customers.
• Remain informed with industry trends and changes in coding payment guidelines.

REQUIRED SKILLS & EXPERIENCE

Required:

• 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) are required prior to hire date.
• 8 years or more relevant healthcare experience as a medical coder, medical claims adjuster, medical claims processor, chart reviewer/auditor, denial management analyst, clinical editing analyst, or payment or medical policy analyst with CPT code guidelines & HCPCS coding experience.
• 2 years or more recent ClaimsXten Content Development experience required.

GENERAL COMPETENCIES

• Initiative-taking and self-directed
• Strong working knowledge 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.
• Knowledge of healthcare reimbursement and payment policies and methodologies.
• Ability to work independently, with minimal direction.
• Strong analytical and critical thinking skills, particularly in reading complex subject material.
• Ability to present extraordinarily complex material verbally in large group settings, as necessary.
• Ability to communicate clearly and concisely in writing.
• Proficiency in Microsoft applications including Excel and Word; Access experience is a plus.
• Conscientiousness

***The US base salary range for this full-time position is:
$119,439.36 - $179,159.04

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. Please note that the compensation details listed in US role postings reflect the base salary only, and does not reflect the value of the total rewards compensation. ***

Lyric is an Equal Opportunity Employer that strives to create an inclusive environment, empower employees and embrace collaborative success.