Lyric is the trusted leader in healthcare decision intelligence. Built on more than 35 years of proven results, Lyric combines responsible AI with clinical, payment, regulatory, and policy expertise to deliver transparent, auditable insights in milliseconds across real-time claims workflows. Lyric augments human decision-making so health plans can make faster, more accurate payments while maintaining full control. Today, Lyric supports 200 million lives, with nine of the top 10 U.S. health plans relying on its platform to reduce waste, improve efficiency, and support accurate payments.
Essential Job Responsibilities & Key Performance Outcomes
- Assist with researching Medicare, Medicaid, Specialty Society, and other medical coding authority publications to locate covered and non-covered guideline language.
- Enter clinical content into Lyric software accurately, following established processes and review guidance to support correct claim outcomes.
- Help identify code set and guideline updates by comparing coding authority documentation against existing clinical content.
- Stay informed about routine code set updates, guideline changes, and medical coding requirements with guidance from senior team members.
- Support cross-functional teams by sharing researched coding and billing information and escalating complex subject matter questions to senior analysts or subject matter experts.
- Validate and maintain source documentation for claims editing.
Required Skills and Experience
- Education: Bachelor’s degree in health information management, Nursing or other Healthcare related degree required.
- 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) is required. Apprentice status is acceptable.
- Minimum of one (1) year or more relevant healthcare experience or health insurance payer experience as a payment/reimbursement or medical policy analyst, medical claims processor, chart reviewer/auditor, medical billing, medical clerk or clinical editing analyst.
- Working knowledge of pre-payment editing, payment policies and payment integrity is required.
- Must be initiative-taking and self-directed, with the ability to work independently, with minimal direction.
- 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.
- Strong communication skills: Must be an expert at presenting extraordinarily complex material via all mediums.
- Analytical skills: Candidate must possess the ability to analyze complex data, identify trends and assess potential vulnerabilities.
- Superior critical thinking skills
- Proficiency in Microsoft applications.
