Lyric is an AI-first, platform-based healthcare technology company, committed to simplifying the business of care by preventing inaccurate payments and reducing overall waste in the healthcare ecosystem, enabling more efficient use of resources to reduce the cost of care for payers, providers, and patients. Lyric, formerly ClaimsXten, is a market leader with 35 years of pre-pay editing expertise, dedicated teams, and top technology. Lyric is proud to be recognized as 2025 Best in KLAS for Pre-Payment Accuracy and Integrity and is HI-TRUST and SOC2 certified, and a recipient of the 2025 CandE Award for Candidate Experience. Interested in shaping the future of healthcare with AI? Explore opportunities at lyric.ai/careers and drive innovation with #YouToThePowerOfAI.
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
