Medical Content Analyst

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. Interested in shaping the future of healthcare with AI? Explore opportunities at lyric.ai/careers and drive innovation with #YouToThePowerOfAI.

The Medical Content Analyst will research and identify Medicare, Medicaid, and other medical coding and billing documents to identify claim denial 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. The Medical Content Analyst will provide written and oral presentations to Medical Director (physicians) and other clinical colleagues to obtain consensus on proposed denial criteria. The Medical Content Analyst will provide clinical content support to our customers as needed. The Medical Content Analyst will perform data entry of clinical content updates into database, as needed.

Responsibilities

• 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.
• Responsible for making recommendations within the software for the denial of diagnosis, age, or other criteria on medical claims based on coding guidelines. This task will impact how claims are processed for certain individuals who are members of various insurance payers.

Qualifications:

• BS Nursing, BS Pharmacy or equivalent required.

• 4 years’ experience in medical billing, coding, claims processing, bill and/or chart review/auditing, is required. 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.
• AHIMA Certified Coding Specialist – Physician (CCS-P) or AAPC Certified Professional Coder (CPC) is required.