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
- Provide additions, deletions or updates to diagnosis codes, procedure codes, age minimums & maximums, quantity limitations, place of service limitations and other clinical content criteria
- Provide written and oral presentations to Medical Director (physicians) and other clinical colleagues to obtain consensus on proposed denial criteria
- Provide clinical content support to our customers as needed
- Perform data entry of clinical content updates into database, as needed
- Solve problems related to the interpretation of inpatient coding or ICD-10-CM coding conventions/guidelines for inclusion or exclusion within Lyric business rules
- Responsible for making recommendations within the software for the denial of diagnosis, age, or other criteria on medical claims based on coding guidelines
Required Qualifications
- BS Nursing, BS Pharmacy or equivalent required
- 5 years’ experience in medical billing, coding, claims processing, bill and/or chart review/auditing, is required. Previous experience working with US health insurance payers in a claims, appeals or coding capacity is also required
- Experience in denial management or claim review management is a plus
- Excellent communication skills (verbal and written) enabling effective communication both internally with all areas of the business and externally
- Demonstrated proficiency with various software applications, including but not limited to: MS Word; MS Excel; MS Access; Visio; JIRA; SharePoint with MS project a plus
- AHIMA Certified Coding Specialist – Physician (CCS-P) or AAPC Certified Professional Coder (CPC) is required
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
