Simplifying the business of care.
Medical Content Analyst, Specialist – Pre-Pay Policy
Location
Pennsylvania
Posted
4 days ago
Salary
$125.2K - $187.9K / year
Seniority
Lead
Job Description
Medical Content Analyst, Specialist – Pre-Pay Policy
Lyric - Clarity in motion.
• 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.
Job 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).
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