New Opportunity Consultant

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. 

The New Opportunities Consultant drives the development and adoption of new content for Lyric’s Secondary Editing clients. The Consultant will work with analytical and clinical partners to identify secondary concepts (and other sources like KCL), review and analyze client specific data for sizing, develop package for presentation, deliver to client and drive any additional action (questions, additional data, etc.) through final client decision (accept/decline). This process will typically apply to clients who have already contracted for Secondary Editing logic. On occasion, they may also apply to clients in a pre-sales process. 

Identification, development and presentation of secondary concepts to new and existing clients  

• Leverage existing resources (Secondary Concept Library, Knowledge Concept Library (KCL), Unlicensed Default CXT content, client recommended content and/or ad hoc evaluation of client’s gaps in potential logic to identify concept(s) 
• Work with analytic tools and resources to run concept(s) against a specific client data set  
• Review output of data set to determine viability of concept(s) for client 
• Package concept(s) using existing (or creation of new) templates  
• Present concept(s) to client and support any feedback/questions  
• Drive (in support with Engagement Manager) final decision from client (accept/decline)  
• Transition approved concept(s) to Payment Accuracy Advisor for requirements sessions and attend/support sessions as needed  
• Document all applicable steps/updates in Client Tracker

Monitor effectiveness of secondary content for assigned clients  

• Proactively monitor implemented concepts (using existing analytic tools and resources) for: 
• Variances in savings (spikes, drops, differences from original projections) and understand drivers 
• Client feedback 
• Clinical feedback 
• Attend various standing and ad hoc meetings to review financial performance and provide guidance on rule performance  
• Support Engagement Manager and PAA in development and/or maintenance of Client Visualization/Roadmap tool 
• Support clinical resources in identification and development of new secondary concepts  
• Ideate and develop new concept package (concept, sourcing, rationale, etc....) in Concept Tracker 
• Attend standing and ad hoc meetings around new concept development and provide feedback on viability  
• Support evaluation of newly developed concept examples that were run through Benchmark Analytics process 

Required Qualifications:

• Education: Bachelor’s degree or 8+ equivalent years’ experience  
• 5+ years of healthcare experience as a medical coder, medical claims adjuster, medical claims processor medical auditor, clinical editing analyst, or payment or medical policy analyst 
• 5+ years’ experience with packaging data outputs in logical format and confidence in presenting to internal/external partners  
• 5+ years working knowledge of CPT codes, HCPCS codes, ICD-10-CM codes and other code sets 

Preferred Qualifications:

• American Academy of Professional Coders (AAPC) Certified Professional Coders (CPC) certification or American Health Information Management Association (AHIMA) Certified Coding Specialist-Physician (CCS-P)  
• Health plan experience  
• Experience with other clinical editing vendors 
• Experience with Lyric software (e.g. ClaimsXten) 
• Ability to successfully manage multiple priorities with deliverables completed on time and with high quality 
• Research capabilities, writing experience, and current working knowledge of government and commercial payer guidelines required 
• Demonstrated proficiency with various software applications, including but not limited to: MS Word; MS Excel; Outlook, MS PPT 
• Outstanding problem-solving skills as demonstrated by ability to step through logical pathways to confirm expected results 
• Strong analytical skills 

This job description is not intended to be all-inclusive.  The supervisor or other management may assign other reasonably related business duties. Management reserves the right to change job responsibilities, duties, and hours as needs prevail.  This job description is not intended to imply a written or implied contract of employment. 

The work environment characteristics below are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be provided to enable individuals to perform the essential functions. Reach out to Human Resources to discuss any reasonable accommodation requests that are made.

Sitting/Standing/Walking Requirement 

Standing and walking requirements are minimal. The sitting requirement may be for a duration of 8 hrs. or longer to perform work on a computer.  

Visual Acuity Requirement 

Continuously required for duration of 8 hrs. or longer to read and see small detail on computer screen.  

Verbal Communication Requirement 

Continuously required to communicate by means of spoken work; participates in activities where spoken instructions must be conveyed to others accurately or quickly in person. 

Repetitive Motion Requirement 

Constantly required for duration of 8 hrs. or longer to make repetitive movements of the wrists, hands, and /or fingers through use of computer.

***The US base salary range for this full-time position is:

$119,439.36 - $179,159.04

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.