Senior Medical Content Analyst
At a glance
Senior Content Creation role at Tbc. Manila · full-time.
Pay not stated Content Creation salary
growthroles summary, based on the employer's posting.
What you'll do
- Revise clinical rules covering diagnosis and procedure codes, age ranges, quantity limits, service locations, and related criteria
- Present proposed denial rules to physician medical directors and clinical colleagues, then build agreement on them
- Help customers with clinical content questions and enter approved updates into the database when needed
- Resolve inpatient and ICD-10-CM coding interpretation issues that affect whether business rules include or exclude claims
- Recommend software criteria for denying claims based on diagnoses, age, and coding guidance
What you bring
- A nursing, pharmacy, or equivalent bachelor’s degree is required
- At least five years in medical billing, coding, claims processing, or bill or chart review and auditing
- Prior work with U.S. health insurers in claims, appeals, or coding is required
- You need a CCS-P or CPC coding credential
- Strong written and spoken communication, plus proficiency with applications such as Word, Excel, Access, Visio, JIRA, and SharePoint
Who this fits
This senior role suits someone experienced in U.S. payer claims or coding who can explain clinical rules to physicians and customers. The role is based in Manila, Philippines.
From the employer
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
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