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.
JOB SUMMARY
The Content Innovation team is integral to the success of the content development process of Lyric and the expansion of our claims editing solutions. This team member will support development and optimization of AI-driven healthcare solutions. This role bridges clinical coding expertise with artificial intelligence, ensuring that model outputs are accurate, compliant and aligned with claims editing.
ESSENTIAL JOB RESPONSIBILITIES & KEY PERFORMANCE OUTCOMES
- Verify coding or billing guidelines and other data extracts from AI to confirm accuracy in accordance with coding parameters.
- Review Medicare/Medicaid/Commercial guidelines and create/maintain policies
- 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.
REQUIRED QUALIFICATIONS
- Bachelor’s degree in MBBS/BAMS/BHMS/BDS/BPT with completed internship
- 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)
- Minimum of 2 years of relevant US healthcare experience, 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
- Proficiency in Microsoft applications
PREFERRED QUALIFICATIONS
- Bachelor’s degree in healthcare related field
- Previous US Healthcare in Payer/Provider specific experience
- Previous experience in Medicaid/Commercial policy reimbursement guidelines
- Previous experience at CMS (Medicare or Medicaid) or at a Health Insurance plan
- Comfortable working in agile, fast-paced, and collaborative environments
- Self-motivated and proactive, with the ability to work independently and with minimal supervision
- Strong analytical and critical thinking skills
Skills Required
- Bachelor's degree in MBBS, BAMS, BHMS, BDS, or BPT with completed internship
- Active AAPC Certified Professional Coder (CPC) or AHIMA Certified Coding Specialist Physician (CCS-P) certification
- At least 2 years of relevant US healthcare experience
- Proficiency applying CPT, ICD-10-CM, and HCPCS coding conventions
- Experience translating clinical documentation into appropriate codes
- Understanding of Commercial, Medicare, and Medicaid payers, including FFS and MCOs
- Understanding of third-party claims processing, including paper and EDI processes
- Strong knowledge of medical terminology and human anatomy
- Proficiency with Microsoft applications
- Bachelor's degree in a healthcare-related field
- US healthcare experience in payer or provider environments
- Experience with Medicaid or commercial policy reimbursement guidelines
- Experience at CMS or a health insurance plan
- Ability to work in agile, fast-paced, collaborative environments
- Self-motivated and able to work independently with minimal supervision
- Strong analytical and critical thinking skills
What We Do
Welcome. Let us help bring your health plan's payment accuracy and savings into the next era of savings and cost reduction. Learn more by visiting Lyric.AI Welcome to Lyric. Building on the legacy of ClaimsXten, we bring over 30 years of expertise to deliver unmatched savings—more than $14 billion annually—to our valued clients, including 9 of the top 10 health payers nationwide. Our cutting-edge solutions streamline complex claims processes, ensuring precision and efficiency for over 185 million lives under our care. Recognized by KLAS for our partnership excellence and value, we lead with top customer satisfaction scores and an A+ recommendation rate. Apart from our market-leading pre-pay claim editing services, Lyric is at the forefront of integrating advanced technologies to drive greater savings and administrative cost savings through the payment integrity value chain. This includes strategic partnerships with leaders in the areas of genetic testing claims accuracy, coordination of benefits, and more. Whether you are a current valued customer or new to Lyric, we are investing in helping health plans simplify the business of care. Visit us at Lyric.AI
