Clinical Development - Medical Requirements

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. 

Job Summary:

The Medical Writer – Requirements team member is integral to the success of the policy and business development process at Lyric. The Medical Writer – Requirements is responsible for the analysis and documentation of the clinical requirements for use in the business rule requirements for policy and rule specification creation. This role is vital to the expansion and effectiveness of our ClaimsXten editing packages and helps promote payment accuracy.

What you'll be doing:

• Analyze, gather, and document clinical requirements using best practices as defined by Clinical management.
• Validate clinical requirements including content requirements, in collaboration with subject matter experts (e.g., ClaimsXten experts, Certified coders, auditors, consultants, Medical Directors, etc.,) to guarantee correct coding guideline interpretations.
• Collaborate with Rule Writers team and cross-functional team members, to evaluate rule/policy behavior and to confirm that solution requirements meet business expectations and align with client implementation standards.
• Document content requirements to promote immediate post release content maintenance handoffs.
• Serve as a contributor to all user documentation (edit clarifications, Rules Guide, etc.,)
• Assist with all end-user training activities.
• Support Quality Assurance test plan validation.
• Perform user acceptance testing (UAT) of policies and/or rules.
• Provide requirements subject matter expertise to internal and external clients.

Required Qualifications:

• Education: Bachelor’s degree in health information management, Nursing or other Healthcare related degree required, or 4 additional years of experience listed below in lieu of 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) is required.
• 5+ years healthcare experience, with at least 2 years experience as a payment/reimbursement or medical policy analyst, medical coder, medical claims processor, chart reviewer/auditor, or clinical editing analyst.
• 2+ years experience with ClaimsXten solution.

Preferred Qualifications:

• Knowledge of the Software Development Life cycle.
• Master’s degree in healthcare related field.
• Knowledge of healthcare reimbursement and payment policies and methodologies.
• Working knowledge of pre-payment editing and payment integrity is preferred.
• Must be initiative-taking and self-directed,
• Ability to work independently, with minimal direction.
• Effective communication skills: Must be an expert at presenting extraordinarily complex material via all mediums.
• Analytical skills: Candidate must 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:

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.