Staff Medicare/Medicaid Regulatory Affairs Analyst

March 26

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Lyric - Clarity in motion.

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Lyric is a leading healthcare technology company focused on payment integrity and accuracy solutions. With over 30 years of experience, Lyric aims to simplify the business of care by leveraging machine learning and predictive analytics to empower health plan payers. The company provides a range of solutions, including Lyric 42 Platform, Pre-Pay Editing, Diagnostics Module, Coordination of Benefits, Concept Libraries, and LyricIQ, which combines AI-powered payment accuracy services. Additionally, Lyric focuses on transparency and responsibility in technology development, ensuring enhanced payment accuracy, administrative efficiencies, and reduced provider abrasion. As a trusted partner in the healthcare industry, Lyric continues to deliver cutting-edge technologies at the crossroads of healthcare and fintech, supporting health plans and providers in the shift to value-based care.

healthcare technology • claims editing • primary editing • secondary editing • solution hosting

201 - 500 employees

⚕️ Healthcare Insurance

💳 Fintech

☁️ SaaS

📋 Description

• 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. • 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.

🎯 Requirements

• 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. • Master’s degree in business or healthcare related field (preferred) • Previous experience as a Compliance Officer (preferred) • 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 (preferred) • Extensive understanding of compliance regulations • 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 • Analytical skills • Proficiency in Microsoft applications