Medical Content Analyst, Specialist (Pre-Pay Policy)

Pre-Pay Policy Specialist

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 and drive innovation.

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.

Essential Job Responsibilities & Key Performance Outcomes

• 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.

Required Qualifications

• 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.

Preferred Qualifications

• 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.

***The US base salary range for this full-time position is:

$125,241.00 - $187,862.00

The specific salary offered to a candidate may be influenced by a variety of factors including but not limited to the candidate's relevant experience, education, and work location. Please note that the compensation details listed in US role postings reflect the base salary only, and does not reflect the value of the total rewards compensation. ***

Lyric is an Equal Opportunity Employer that strives to create an inclusive environment, empower employees and embrace collaborative success.