Medical Content Analyst

Lyric; Manila; On-site; PHP 350,000 - 550,000; Full time

Job summary

Lyric, a leader in healthcare decision intelligence, seeks a qualified professional to manage clinical content for claims and coding. You will update diagnosis and coding criteria, present denial criteria to physicians, and support customers with authoritative content.

The role requires a nursing background (BS) and 4+ years in medical billing/coding, with US payer experience and CCS-P or CPC certification. Strong communication and software skills are essential.

Qualifications

• BS Nursing or equivalent is required.
• 4 years’ experience in medical billing, coding, claims processing, or chart review/auditing.
• Experience with US health insurance payers in claims, appeals or coding capacity.
• Experience in denial management or claim review is a plus.
• Excellent verbal and written communication skills.
• Proficiency with MS Office, Visio, JIRA, SharePoint; MS Project a plus.
• AHIMA CCS-P or AAPC CPC certification is required.

Responsibilities

• Update diagnosis codes, procedure codes, age limits, quantity limits and other clinical criteria.
• Present to Medical Director and clinicians to gain consensus on denial criteria.
• Provide clinical content support to customers as needed.
• Enter clinical content updates into the database.
• Address issues in inpatient coding and ICD-10-CM conventions for Lyric rules.
• Recommend software-based denial decisions based on coding guidelines.

Skills

Medical billing

Medical coding

US payer experience

Denial management

Communication

Software literacy

Education

BS Nursing

AHIMA CCS-P

AAPC CPC

Tools

MS Word

MS Excel

MS Access

Visio

JIRA

SharePoint

MS Project

Job description

Lyric is the trusted leader in healthcare decision intelligence. Built on more than 35 years of proven results, Lyric combines responsible AI with clinical, payment, regulatory, and policy expertise to deliver transparent, auditable insights in milliseconds across real-time claims workflows. Lyric augments human decision-making so health plans can make faster, more accurate payments while maintaining full control. Today, Lyric supports 200 million lives, with nine of the top 10 U.S. health plans relying on its platform to reduce waste, improve efficiency, and support accurate payments.

Essential Job Responsibilities & Key Performance Outcomes

• Provide additions, deletions or updates to diagnosis codes, procedure codes, age minimums & maximums, quantity limitations, place of service limitations and other clinical content criteria
• 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

Required Skills & Experience

• BS Nursing 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