Tbc
Payment Integrity Analyst - Data Mining
Remote - US · Full-time
Work authorization required$24k-$36kDetected 30 days ago
Data AnalysisComplianceExcelAuditingRecruitingHIPAAICD-10ResearchCommunicationCollaborationProblem SolvingClaims Management
About the role
- Collaboration, documentation, and system updates
- Analyze claim inventory from identification to resolution.
- Assist in compiling sample claims and supporting documentation for Client review and approval.
Responsibilities
- Review, prioritize, and independently work assigned DM leads (automated and manual), including moderate-to-complex and high-dollar cases, to determine verification steps and next actions.
- Investigate and validate payment terms (Inpatient, Outpatient, Professional, Ancillary) using internal systems, payer portals, contracts, and other approved data sources.
- Reconcile discrepancies across sources (contract data and paper forms, conflicting policy and contract terns) and drive cases to a clear, audit-ready determination; escalate edge cases per policy.
- Analyze claim inventory from identification to resolution. Assist in developing concept overviews and analysis. Collaborate with team to configure client specific business rules.
- Assist in compiling sample claims and supporting documentation for Client review and approval. Maintain a library that includes instructions for validating specific audit concepts.
- Create clear, detailed, and accurate case notes that capture verification steps, evidence, and outcomes in internal tools to support audits and downstream recovery/reprocessing.
- Provide validated DM outcomes that support downstream payment integrity activities (recovery, reprocessing, adjustments) with minimal rework.
- Reconcile discrepancies across sources (eligibility feeds, member/group data, claim history, and third-party responses) and drive cases to a clear, audit-ready determination.
- Use Excel and other tools to support ad hoc analysis (e.g., trend review, inventory quality checks, and performance insights); partner with stakeholders to clarify requirements and improve workflows.
- Payment integrity support & Operational excellence
Requirements
- Lyric, formerly ClaimsXten, is a market leader with 35 years of pre-pay editing expertise, dedicated teams, and top technology.
Nice to have
- Experience in various claim payment methodologies for professional, facility, and ancillary providers or working knowledge of payment integrity auditing concepts.
- Experience with SQL.
- Experience within high-volume, SLA-driven operations teams.
- Creative thinker with an entrepreneurial spirit.
- Strong written and verbal communication skills.
- Excellent documentation accuracy and attention to detail.
- Ability to work within established productivity and quality metrics.
- Comfortable navigating multiple systems, portals, and payer interfaces.
Compensation
- 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. ***
Benefits
- Apply payment policies, contract terms and coding guidelines, including CMS and AMA guidance as applicable, to determine the correct reimbursement and document the rationale for the payment determination.
Equal opportunity
- Lyric is an Equal Opportunity Employer that strives to create an inclusive environment, empower employees and embrace collaborative success.
Visa & Work Authorization
- Applicants must already be legally authorized to work in the U.S. Visa sponsorship/sponsorship assumption and other immigration support are not available for this position.
This listing is sourced directly from Tbc's careers page and normalized into a canonical job model.