Lyric is the trusted leader in healthcare decision intelligence. Built on more than 35 years of proven results, Lyric combines responsible AI with clinical, payment, regulatory, and policy expertise to deliver transparent, auditable insights in milliseconds across real-time claims workflows. Lyric augments human decision-making so health plans can make faster, more accurate payments while maintaining full control. Today, Lyric supports 200 million lives, with nine of the top 10 U.S. health plans relying on its platform to reduce waste, improve efficiency, and support accurate payments.
Essential Job Responsibilities & Key Performance Outcomes
- Review and validate AI generated CPT, HCPCS, ICD10CM and other claim data set elements.
- Verify coding or billing guidelines and other data extracts from AI to confirm accuracy in accordance with coding parameters.
- Identify any AI data extract anomalies or defects.
- Provide accurate and timely feedback to AI to improve model performance.
- Remain informed with medical coding and billing regulatory changes to contribute continuous improvement of AI tools.
- Participate in the development of coding guidelines for AI-assisted workflows.
- Validate criteria for policy or rule suitability.
- Serve as a subject matter expert (SME) in cross-functional team with Clinical, technical, and product stakeholders.
Required Qualifications
- Bachelor’s degree in health information management, Nursing or other Healthcare related degree required
- Active American Academy of Professional Coders (AAPC) Certified Professional Coders (CPC) certification or American Health Information Management Association (AHIMA) Certified Coding Specialist-Physician (CCS-P) or Certified Coding Specialist (CCS)
- Minimum of 5 years of relevant healthcare experience, including at least 3 years in medical coding, chart review, auditing, or abstraction. Must demonstrate proficiency in applying CPT, ICD-10-CM, and HCPCS coding conventions, including translating clinical documentation into appropriate codes.
- Understanding of US health insurance payers including Commercial, Medicare, Medicaid (FFS and MCOs), third-party claims processing (including paper & EDI processes)
- Strong grasp of medical terminology and human anatomy
- Familiarity with AI-driven tools such as Computer-Assisted Coding (CAC) or Natural Language Process (NLP) platforms
- Proficiency in Microsoft applications
Preferred Qualifications
- Master’s degree in business or healthcare related field
- Previous ClaimsXten experience
- Previous experience using AI tools in a professional environment
- Previous experience at CMS (Medicare or Medicaid) or at a Health Insurance plan
- Ability to convey complex technical information across various formats (written, verbal, visual)
- Comfortable working in agile, fast-paced, and collaborative environments
- Willing to participate in target AI training programs
- Self-motivated and proactive, with the ability to work independently and with minimal supervision
- Strong analytical and critical thinking skills
