Staff Medicare/Medicaid Regulatory Affairs 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. 

The Regulatory Affairs Analyst is responsible for the identification and communication of all federal and state regulations related to claims editing, reimbursement, prior authorization and other healthcare related topics. The Regulatory Affairs Analyst will be the subject matter expert on topics related to Medicare, Medicaid, claims editing legislation and other healthcare related matters. A key duty of this role is the timely communication of any legislative updates impacting areas of Lyric’s business.

ESSENTIAL JOB RESPONSIBILITIES & KEY PERFORMANCE OUTCOMES

• Monitor publications, databases and regulatory sites to identify legislation changes impacting claims editing, reimbursement, coverage and other healthcare related topics
• Communicate regulatory and legislative updates to Clinical team and other key stakeholders; provide regular regulatory updates
• Provide recommendations to clinical and product leadership, based on review of legislative findings
• Submit regulatory questions to all federal and state entities, on behalf of internal and external clients
• Proactively identify areas of potential vulnerabilities within Lyric solutions and assist with mitigation strategies
• Lead and support client-facing discussions related to federal, state and other healthcare legislative matters
• Remain informed about changes in healthcare regulations and provide regular communications to key clinical and product stakeholders.

REQUIRED QUALIFICATIONS

• Bachelor’s degree in healthcare administration, Nursing or the other Healthcare related degree
• Minimum of eight (8) years’ experience in Corporate or Healthcare compliance
• Minimum of eight (8) years experience as a medical coder, medical claims adjuster, medical claims processor, chart reviewer/auditor, denial management analyst, clinical editing analyst, or payment or medical policy analyst required.
• AAPC Certified Professional Coder (CPC) or AHIMA Certified Coding Specialist – Physician (CCS-P) required.

PREFERRED QUALIFICATIONS

• Master’s degree in business or healthcare related field
• Previous experience as a Compliance Officer
• Certification In Healthcare Compliance (CHC) or Certified Professional Compliance Officer (CPCO) preferred.
• Previous experience at CMS (Medicare or Medicaid) or at a Health Insurance plan
• Must demonstrate a high level of initiative
• Extensive understanding of compliance regulations: Must possess current working knowledge of state and federal legislation, related to healthcare such as claims editing, prior authorization, medical necessity and other associated topics.
• Previous experience interpreting complex legislation such CMS Final Rules, Federal Register, etc.
• Proven ability to contact regulatory entities and receive timely, concise responses to complicated coverage, policy or coding questions
• Strong communication skills: Must be an expert at presenting extraordinarily complex material via all mediums
• Analytical skills: Must possess the ability to analyze complex data, identify trends and assess potential vulnerabilities
• Superior critical thinking skills
• Proficiency in Microsoft applications

***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.