Medical Content Analyst

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 the 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 the 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.
• Make recommendations within the software for the denial of diagnosis, age, or other criteria on medical claims based on coding guidelines.

Required Skills & Experience

• BS in Nursing or equivalent requ...