Medical Content Analyst (RN with CPC) | Night Shift | WFH Set Up

4-6 years
8 days ago
Job Description

ABOUT THE CLIENT:

Lyric is a healthcare technology company that offers services in reducing healthcare costs through clinical content analytics and automation.

Lyric takes the guesswork out of the payment accuracy cycle. Through decades of experience with the healthcare industry, we've created a suite of solutions that is designed to seamlessly integrate with the claims processing workflow.

Lyricu0027s headquarters is currently located in King of Prussia, Pennsylvania. You might have known us as ClaimsXten, but now as Lyric, we're evolving to address the healthcare ecosystem with more clarity than ever before.

Lyric has over 30 years of industry experience and is backed by TPG Capital. TPG is a leading global asset manager and focuses on improving customer experience by accelerating investments in innovation-led growth.

Position Summary:

The Medical Content Analyst will be responsible in conducting research and identify Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria (clinical content) for our automated claims editing solution.

This solution is utilized by medical insurance payers across the United States. The clinical content could include additions, deletions or updates to diagnosis codes, procedure codes, age minimums & maximums, quantity limitations, place of service limitations and other clinical content criteria.

Duties and Responsibilities:

  • Research and identify Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria (clinical content) for our automated claims editing solution.
  • Provide written and oral presentations to Medical Director (physicians) and other clinical colleagues to obtain consensus on proposed denial criteria.
  • Provide clinical content support to our customers as needed
  • Perform data entry of clinical content updates into database, as needed
  • Solve problems related to the interpretation of inpatient coding or ICD-10-CM coding conventions/guidelines for inclusion or exclusion within Lyric business rules.

Qualifications:
  • Bacheloru0027s Degree in Nursing.
  • Must have an Active RN (PRC) License.
  • AHIMA Certified Coding Specialist - Physician (CCS-P) or AAPC Certified Professional Coder (CPC) is required.
  • With 4 years experience in medical billing, coding, claims processing, bill and/or chart review/auditing, is required.
  • Preferably with experience in CPT Coding.
  • Previous experience working with US health insurance payers in a claims, appeals or coding capacity is also required.
  • Experience in denial management or claim review management is a plus.
  • Excellent communication skills (verbal and written) enabling effective communication both internally with all areas of the business and externally.
  • Demonstrated proficiency with various software applications, including but not limited to: MS Word, - MS Excel, MS Access, Visio, JIRA, Sharepoint with MS project a plus.



JOB TYPE

Function

Skills

Database
ICD-10-CM
clinical content analytics
clinical content support

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