Senior Medical Content Analyst

Location: Manila, Philippines

Company

Lyric provides healthcare decision intelligence that combines responsible AI with clinical, payment, regulatory, and policy expertise to support transparent and auditable claims decisions.

What you will do

• Maintain clinical content by adding, deleting, and updating diagnosis codes, procedure codes, age limits, quantity limits, place-of-service limits, and other criteria.
• Develop recommendations for denying diagnosis, age, and other criteria on medical claims based on coding guidelines.
• Interpret inpatient coding and ICD-10-CM conventions for inclusion or exclusion in business rules.
• Present proposed denial criteria to Medical Directors and clinical colleagues to reach consensus.
• Provide clinical content support to customers and enter approved updates into the database.

Requirements

• BS in Nursing, BS in Pharmacy, or an equivalent qualification.
• At least 5 years of experience in medical billing, coding, claims processing, bill or chart review, or auditing.
• Previous experience with US health insurance payers in claims, appeals, or coding is required.
• AHIMA CCS-P or AAPC CPC certification is required.
• Strong written and verbal communication skills, analytical and critical-thinking abilities, and proficiency with software such as Microsoft Word, Excel, Access, Visio, JIRA, and SharePoint.

Nice to have

• Experience in denial management or claim review management.
• Professional experience using AI tools.
• Experience with CMS, Medicare, Medicaid, or a health insurance plan.
• Ability to communicate complex technical information in written, verbal, and visual formats.
• Experience working in agile, fast-paced, collaborative environments and willingness to participate in AI training programs.

Culture & Benefits

• Work in a collaborative, agile, and fast-paced environment.
• Support customers through clinical content expertise and healthcare decision intelligence.
• Opportunities to participate in targeted AI training programs.
• Work independently with minimal supervision while contributing to cross-functional clinical discussions.