Payment Integrity Analyst

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. 

Applicants must already be legally authorized to work in the U.S.  Visa sponsorship/sponsorship assumption and other immigration support are not available for this position.

The Data Analyst will support excellence of execution with post payment customer deliverables through data analysis, enhancing data models and creating/improving automation of processes. In addition, the Data Analyst will engage with customers and internal partners to deliver services to Lyric post payment integrity customers.

Responsibilities

• Research new customer specific value opportunities; create SQL queries, analyze data; size opportunity and present potential value back to leaderships (40%)
• Improve existing models by analyzing model performance against benchmarking, identifying gaps and providing recommendations. (10%)
• Identify opportunities for further automation of repetitive tasks. (10%)
• Support the payment integrity team in a variety of business processes including but not limited to processing medical insurance claim overpayments through recovery (40%)
• Review claims for missing or incomplete information, calculate payment, or validation of identified overpayments.
• Reconcile submission response files, work with key stakeholders to resolve issues and ensure outstanding response pipeline is current.
• Process overpayments (provider refunds) requests, support notification letters process.
• Recognize and document system issues.
• Keep abreast of the changes in regulations, program policies and current processing procedures.
• Ensure legal compliance by following company policies, client policies, procedures, guidelines, as well as state and federal regulations.
• Collaborate with clients to resolve provider disputes and inquiries
• Maintain productivity goals and standards set by the department
• Process overpayments (provider refunds, adjustments, offsets) request

Required Qualifications:

• 1+ years of SQL programming/queries, as well as advanced excel experience
• 1+ Years’ experience auditing medical claims to identify improper payments as a Payment Integrity Vendor or within a Health Plan’s Payment Integrity team.
• 1+ years of experience performing data analytics with large data sets

Preferred Qualifications:

• Bachelors degree in business or healthcare/related field
• 1+ years of experience with automation tools (e.g. UIPath)
• 1+ years of combined experience in healthcare, such as prior work in health insurance, claims processing or adjudication, or fraud, waste and abuse detection
• 1+ years of experience in medical billing codes including but not limited to CPT, ICD-10-PCS, ICD-10-CM, HCPCS, and NDC, as well as an understanding of medical terminology, and prospective payment systems including DRG, OPPS, and MIPS
• Creative thinker with an entrepreneurial spirit
• Strong verbal and written communication skills
• Experience in various claim payment methodologies for professional, facility, and ancillary providers
• Working knowledge of payment integrity auditing concepts

***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.