Medical Content Analyst, Specialist (Pre-Pay Policy)
About The Position
Lyric is an AI-first, platform-based healthcare technology company, committed to simplifying the business of care by preventing inaccurate payments and reducing overall waste in the healthcare ecosystem, enabling more efficient use of resources to reduce the cost of care for payers, providers, and patients. Lyric, formerly ClaimsXten, is a market leader with 35 years of pre-pay editing expertise, dedicated teams, and top technology. Lyric is proud to be recognized as 2025 Best in KLAS for Pre-Payment Accuracy and Integrity and is HI-TRUST and SOC2 certified, and a recipient of the 2025 CandE Award for Candidate Experience. The Pre-Pay Policy Specialist is an integral contributor to the success of the client’s utilization of ClaimsXten. This individual serves as a subject matter expert on Lyric’s clinical content and acts as a liaison between Lyric clients and our cross-functional teams, providing oversight and guidance on important content related topics.
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.
Nice To Haves
- Master’s degree in business or healthcare related field.
- Previous experience as a medical coder.
- Previous experience at a Health Insurance plan.
- Strong knowledge of pre-payment editing, payment policies and payment integrity.
- 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.
- Takes initiative and works independently with minimal direction.
- Strong communication skills including expert level at presenting extraordinarily complex material via all mediums.
- Possess the ability to analyze complex data, identify trends and assess potential vulnerabilities.
- Superior critical thinking skills.
- Proficiency in Microsoft applications.
Responsibilities
- 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.
Benefits
- Equal Opportunity Employer that strives to create an inclusive environment, empower employees and embrace collaborative success.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
