AVP, Pre-Pay Review Solutions

Lyric, formerly ClaimsXten, is a leading healthcare technology company, committed to simplifying the business of care. Over 30 years of experience, dedicated teams, and top technology help deliver more than $14 billion of annual savings to our many loyal and valued customers—including 9 of the top 10 payers across the country. Lyric’s solutions leverage the power of machine learning, AI, and predictive analytics to empower health plan payers with pathways to increased accuracy and efficiency, while maximizing value and savings. Lyric’s strong relationships as a trusted ally to customers resulted in recognition from KLAS as “true partner” and “excellent value for investment,” with a top score for overall customer satisfaction and A+ likelihood to recommend in their October 2023 Payment Integrity and Accuracy Report. Discover more at Lyric.ai. 

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.

The AVP, Pre-Pay Review Solutions is responsible for leading Lyric’s end-to-end pre-pay review business, with accountability for customer adoption, operational performance, and financial results. This role partners with a global delivery organization and engages directly with health plan stakeholders to guide solution evaluation, onboarding, and long-term success.

Lyric’s pre-pay review portfolio includes coding review, COB, and record review services (DRG and IBR). This individual will also play a direct role in driving the adoption of Lyric’s Replay platform to payer’s pre-pay audit teams, helping convert opportunities into measurable adoption. The AVP will partner closely with product strategy, engineering, customer success, and implementation teams to ensure alignment across functions and drive solution growth.

The role requires a strong mix of customer-facing experience, operational leadership, and commercial ownership. The AVP will serve as a general manager for this product category, responsible for delivering against revenue, margin, and customer value goals.

ESSENTIAL JOB RESPONSIBILITIES & KEY PERFORMANCE OUTCOMES

Customer Leadership and Solution Adoption

• Serve as the primary business lead for all customer-facing adoption of pre-pay review solutions
• Support health plan stakeholders in evaluating solution fit, gaining internal approval, and ensuring rollout success
• Promote the Replay platform as a critical enabler of pre-pay review effectiveness and efficiency
• Provide clinical and coding guidance to support customer decision-making and ensure defensible audits

Operations Oversight and Global Delivery Management

• Partner with global audit teams that deliver Lyric’s pre-pay review services across all lines of business
• Ensure delivery teams meet accuracy, timeliness, productivity, and compliance expectations
• Oversee workforce planning, quality assurance, and process standardization across onshore and offshore teams
• Continuously improve audit workflows to drive scale, consistency, and operational excellence

Commercial and Financial Stewardship

• Collaborate with finance and product leadership to manage bookings, revenue, and margin for the solution category
• Forecast delivery volume, staffing, and associated costs to meet financial and contractual obligations
• Provide input into deal structuring and pricing strategies to support sustainable growth
• Track and report solution performance metrics that inform future investment and delivery model changes

Internal Collaboration and Solution Development

• Work with product strategy and engineering to ensure operational realities inform roadmap prioritization
• Partner with customer success and implementation teams to streamline customer onboarding and support
• Contribute to strategic planning for the evolution of pre-pay review capabilities and delivery infrastructure.

REQUIRED QUALIFICATIONS

• Minimum of ten (10) years of experience in healthcare claims, coding, or audit operations, with an emphasis on pre-payment integrity
• Strong track record managing global delivery teams with demonstrated outcomes in productivity, accuracy, and compliance
• Proven ability to influence and guide payer clients through complex audit solution adoption
• In-depth knowledge of ICD-10, CPT, DRG methodologies, COB policies, and audit workflows
• Familiarity with payment integrity systems and audit decision tools
• Strong financial and analytical skills with experience managing toward revenue and margin targets
• Exceptional cross-functional communication and leadership capabilities

PREFERRED QUALIFICATIIONS

• Previous leadership experience in a payer-facing audit or consulting role
• Familiarity with workflow automation or AI-enabled audit selection tools

• Experience with audit platforms used in pre-pay or post-pay review
• Customer Engagement: Builds trust with payer stakeholders and drives solution acceptance
• Operational Execution: Manages global teams and ensures efficient delivery at scale
• Business Acumen: Understands key financial drivers and aligns operations with growth objectives
• Strategic Collaboration: Aligns with internal partners to shape the product and delivery roadmap
• Results Orientation: Holds teams accountable to measurable outcomes and service excellence
• Industry Insight: Applies knowledge of audit best practices and market trends to optimize solution value

***The US base salary range for this full-time position is:

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. ***

Lyric is an Equal Opportunity Employer that strives to create an inclusive environment, empower employees and embrace collaborative success.