Senior Medical Content Analyst

Lyric; Manila; On-site; PHP 670,000 - 1,004,000; Full time

Job summary

Lyric, a leader in healthcare decision intelligence, is seeking a qualified clinician with expertise in medical billing, coding, and claims processing. The role requires collaboration with physicians and clinical colleagues to adjudicate denial criteria and update software with policy rules.

The candidate will support clients and ensure accurate coding and billing practices. Candidates should have 5 years of relevant experience, strong communication skills, and proficiency with common MS Office

Qualifications

• BS Nursing or BS Pharmacy or equivalent is required.
• 5 years of medical billing/coding/claims processing experience is required.
• Experience with US health insurance payers in claims, appeals or coding is required.
• Excellent written and verbal communication skills.
• Proficiency with MS Word, Excel, Access, Visio, JIRA, and SharePoint.

Responsibilities

• Provide updates to diagnosis/coding content criteria.
• Present criteria to Medical Director and clinical colleagues for consensus.
• Provide clinical content support to customers as needed.
• Data entry of clinical content updates into database.
• Interpret inpatient coding and ICD-10-CM guidelines for Lyric rules.
• Make recommendations for denial of criteria based on coding guidelines.

Skills

Medical billing

Medical coding

Claims processing

Communication

Documentation

Education

BS Nursing

BS Pharmacy

Tools

MS Word

MS Excel

MS Access

Visio

JIRA

SharePoint

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 Qualifications

• BS Nursing, BS Pharmacy or equivalent required
• 5 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

Preferred Qualifications

• Master’s degree in business or healthcare related field
• Previous ClaimsXten experience
• Previous experience using AI tools in a professional environment
• Previous experience at CMS (Medicare or Medicaid) or at a Health Insurance plan
• Ability to convey complex technical information across various formats (written, verbal, visual)
• Comfortable working in agile, fast-paced, and collaborative environments
• Willing to participate in target AI training programs
• Self-motivated and proactive, with the ability to work independently and with minimal supervision
• Strong analytical and critical thinking skills