Payment Accuracy Concept Consultant

Lyric, formerly ClaimsXten, is a leading healthcare technology company, committed to simplifying the business of care. Over 30 years of experience, dedicated teams, and top technology help deliver more than $14 billion of annual savings to our many loyal and valued customers—including 9 of the top 10 payers across the country. Lyric’s solutions leverage the power of machine learning, AI, and predictive analytics to empower health plan payers with pathways to increased accuracy and efficiency, while maximizing value and savings. Lyric’s strong relationships as a trusted ally to customers resulted in recognition from KLAS as “true partner” and “excellent value for investment,” with a top score for overall customer satisfaction and A+ likelihood to recommend in their October 2023 Payment Integrity and Accuracy Report. Discover more at Lyric.ai. 

The Payment Accuracy Concept Consultant identifies overpayment areas using established industry and government sources, specialty society guidance, industry trends and claims paid data.  Our goal is to help clients address the overpayments in a prepay setting using Secondary edits.  This person must pay attention to detail.  They must understand the medical billing industry. They must stay abreast with industry trends and changes in coding payment guidelines.  They must have an understanding of different payors and differing lines of business, and how claim payment varies across these differences.

Key responsibilities:

• Solve problems by identifying errors and overpayments in claims paid data
• Generate new ideas for claim rule and edits (pre-payment)
• Communicate in an effective manner to socialize concept and drive towards realistic savings opportunity for each concept
• Stay current with new coding/billing/overpayment trends
• Opportunity Evaluation, Analysis and Data Mining
• New Opportunity Implementation, monitoring and measuring
• Prepare, deliver and provide Clinical support related to clinical content to both internal and external customers
• Work on internal, cross-functional teams focused on both internal and external software applications
• Serve as Clinical Content SME on cross-functional teams, as needed and communicate relevant information back to the Clinical content team

Requirements:

• American Academy of Professional Coders (AAPC) Certified Professional Coders (CPC) certification or American Health Information Management Association (AHIMA) Certified Coding Specialist-Physician (CCS-P) is required prior to hire date
• 5+ years relevant healthcare experience as a medical coder, medical claims adjuster, medical claims processor medical auditor, Clinical editing analyst, or payment or medical policy analyst
• Bachelor’s degree in, Healthcare Information System Management, Health Information Management or other Healthcare related degree desired
• 5+ years experience in third-party claims processing, Medicare/Commercial insurance billing, and/or accounts receivable follow-up analysis experience required
• Ability to travel up to 10%

Preferred Requirements:

• Healthcare Systems Information technology background and/or experience strongly preferred
• Health Plan experience
• Medical background (Registered Nurse)
• Experience with other Clinical Editing vendors
• Background working with different claims processing systems (NASCO, Facets QNXT) as well as understanding of different claims pricing systems.

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

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.