Medical Content Analyst, Specialist – Pre-Pay Policy

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Provides guidance on the clinical content and rules/policies of ClaimsXten, including documentation requirements, customizations for clients, and configuration options.

• Facilitates discussions with clients as a subject matter expert, clarifying ClaimsXten edit logic, content sourcing, rationale, and anticipated outcomes for organizations utilizing Lyric’s edits for pre-payment editing.

• Keeps a thorough understanding of Lyric’s product functionality to explain and resolve edit outcomes (e.g., triggers, rule logic, content overlaps, and configuration dependencies).

• Analyzes data analytics to evaluate the effects of content modifications and updates to new CPT/HCPCS/ICD10CM code sets.

• Assists with client escalations concerning Pre-Payment edits, including scenario analysis and the articulation of suggested resolution paths.

• Acts as a Clinical liaison among Clinical Operations, Client Success, and other cross-functional Lyric teams to enhance the value of ClaimsXten edits for clients.

⛳️ Requirements

• A bachelor's degree in health information management, Nursing, or another healthcare-related discipline.

• Certification as a Certified Professional Coder (CPC) from the American Academy of Professional Coders (AAPC) or Certified Coding Specialist-Physician (CCS-P) or Certified Coding Specialist (CCS) from the American Health Information Management Association (AHIMA).

• At least twelve (12) years of relevant experience in healthcare, including a minimum of three (3) years in health insurance payer roles such as payment/reimbursement analyst, medical policy analyst, medical claims processor, chart reviewer/auditor, or clinical editing analyst.

• A minimum of three (3) years of experience with ClaimsXten.

• Master’s degree in business or a healthcare-related field is preferred.

• Previous medical coding experience is preferred.

• Experience working at a Health Insurance plan is preferred.

• Strong understanding of pre-payment editing, payment policies, and payment integrity is preferred.

• Extensive knowledge of US health insurance payers, including Commercial, Medicare, Medicaid (FFS and MCOs), third-party claims processing (both paper and EDI processes), medical coding, and medical billing is preferred.

• Ability to take initiative and work independently with minimal supervision is preferred.

• Excellent communication skills, including the ability to present complex material across various mediums at an expert level, are preferred.

• Capable of analyzing complex data, identifying trends, and evaluating potential vulnerabilities is preferred.

• Exceptional critical thinking abilities are preferred.

• Proficiency in Microsoft applications is preferred.

🏝️ Benefits

• Comprehensive health insurance options.

• Retirement savings plans with employer matching.

• Opportunities for professional development and continuing education.

• Flexible work arrangements.

• Generous paid time off and holiday policies.