Senior Business 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.

Job Summary

We are looking for Subject Matter Expert/Senior Business Analyst on US Healthcare IT products, or portfolio of products, in the Payer segment, with specific focus on Payment Integrity/ Claims Audit functions. Work with the product owner in defining and driving product strategy and roadmap for products. Collaborate with UX and engineering team to drive product design. Translate business needs into BRDs, FRDs, user stories, and use cases Support projects related to Medicare, Medicaid, and/or VA Health Plans.

• Job Responsibilities
  Work with the product owner in defining and driving product strategy and roadmap for products.
• Clearly articulate product vision, strategy, and roadmap to engineering team effectively.
• Developing the portfolio backlog and help execute the roadmap
• Prioritize backlog at feature and user story level with complete understanding of feature.
• Develop and maintain an appropriately prioritized backlog of user stories for implementation.
• Develop appropriately detailed specifications for the product features and user stories so they are clearly understood by the development teams.
• Help develop effective action plans on feedback received during (retro) meetings.
• Collaborate with UX and engineering team to drive product design.
• Developing the prototype UI, click-thru demo site and enhance it to develop the product user interfaces and system interactions.
• Function as an ambassador/knowledge leader for the product internally and externally and as the primary contact for queries related to the product.
• Help engineering team with regards to the domain knowledge as well as system specific functionality, data extraction, validation, and transformations.
• Drive system demo to stakeholders and customers.
• Identify and set up relevant data to build compelling business case/scenarios for client demos and internal + user testing.
• Validate system outputs against expected reimbursement and DRG assignment

Required Qualifications

• Candidate should be a seasoned professional with at least 12+ years’ experience in IT products and solutions development.
• Around 7-10 years of Product Development/Management experience in US Healthcare IT Industry.
• At least 8 years as a Business Analyst/Product Manager with at least 6 years in the payer domain, specifically payment integrity and claims audit functions.
• Well-versed with Agile development process, with at least 8 years of experience as a practitioner
• 5 + years’ experience/direct involvement in defining and driving product strategy and roadmap for products.
• 5+ years of experience breaking down requirements into Feature Level requirements and User Stories in an Agile environment.
• Experience in successfully driving/direct role in end-to-end delivery of data-centric, enterprise-class and multi-tenant SaaS Solutions involving a wide variety of mechanisms, e.g., dashboards, APIs, real time alerts, etc. Experience with delivery of both front-end and back-end work
• Established background in developing software or solutions working with engineering teams and high degree of proficiency in prototyping, iterative development and expert level understanding of Agile principles and processes.
• Strong knowledge of security and privacy standards and stipulations is essential.
• Strong knowledge of Inpatient DRG systems (MS-DRG / APR-DRG).
• Familiarity with hospital billing, coding, and reimbursement workflows.
• Expert knowledge in using tools such as JIRA/Planner, Confluence/SharePoint, Power BI/ Tableau, Teams, Visio/PowerPoint.
• Decent understanding of SAAS products.
• Strong knowledge of Inpatient DRG systems (MS-DRG / APR-DRG).
• Familiarity with hospital billing, coding, and reimbursement workflows.

Preferred Qualifications

• Prior work experience with health plans or audit companies, specifically in the areas below is a big plus.
• Sound knowledge of US healthcare federal, Medicare, Medicaid guidelines, Claim attributes -Claims Review, Processing and Audit,
• Strong understanding on claim forms, Denial management (Claims adjudication) and Revenue Cycle Management, Overpayment Audit, Coordination of benefits (COB), Inpatient Chart Audit
• Work experience with large health plans (US health plans only) with focus on Claims Processing/Adjudication, Subrogation, Recovery Management, Policy Development/Policy Update and Management are relevant/helpful. 
• Exceptional knowledge of health care claims data, formats and data exchange processes is a big plus.