Sr. Manager, Payment Integrity

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.

Lyric’s Payment Integrity Senior Manager is a high-impact, player-coach who establishes operational objectives and work plans to delegate assignments to team members. This leader is accountable for innovation, strategic growth, and day-to-day operational excellence—and is a direct contributor in addition to leading a team of high-performing individual contributors. This leader owns financial outcomes across the payment continuum (pre- and post-pay)—spanning audit/recovery, claims analytics, compliance, and continuous improvement—while serving as the primary production point of contact for clients. The role includes expert-level hands-on work in Data Mining (DM), Coordination of Benefits (COB), and Code Editing to establish and maintain operating policies and procedures, exceed KPIs, expand scope, and accelerate value.

ESSENTIAL JOB RESPONSIBILITIES & KEY PERFORMANCE OUTCOMES

Leadership & Strategy: Establish delivery vision, OKRs, and roadmap; translate client priorities into executable plans that drive growth via concept and scope expansion.

Operational Strategy & Financial Outcomes: Orchestrate the right mix of people, technology, and process to deliver financial KPIs (savings, revenue, margin). Stand up capacity models, deploy automation/workflow controls, govern forecasting/invoicing, and instrument real-time dashboards for KPIs, inventory, and quality. Assists in developing and enforcing budget and P&L.

Operational Excellence: Run day-to-day audit production with rigor—capacity planning, SLAs, QC, incident triage, root-cause analysis, and continuous improvement using Agile/Lean practices and RAID logs.

Post-Pay Recovery Lifecycle (Hands-On): Lead the end-to-end recovery lifecycle, including identification, validation, provider outreach, appeals resolution, offset eligibility, manual collections, and reconciliation; feed root-cause insights back into pre- and post-pay editing to prevent future leakage.

Client Partnership: Act as tactical and strategic liaison; lead stand-ups, QBRs, and executive readouts; ensure policy alignment and transparent communication.

Innovation & Content (Hands-On): Personally design/QA DM concepts, COB primacy logic, and Code Editing rules (pre- and post-pay); partner with product/SMEs to evolve editing strategies, inform the roadmap, and operationalize new concepts with strong governance and change control.

Onboarding & Projects: Leads the execution of initiatives that impact Lyric at a functional level.  Project-manage new launches/expansions, tailor requirements, integration, and training of client processes. Regularly interacts with senior management or executive level on matters concerning functional areas and/or customers.  Requires the ability to change thinking of, or gain acceptance from, others in sensitive situations.

People Leadership: Lead and coach high-functioning audit teams and recovery teams; elevate standards, apply adult-learning based training, and build a culture of ownership and accountability. Direct and final decision making on hiring, termination, and performance management.

Technical Execution (Hands-On): Write/run SQL, validate datasets, and convert business objectives into clear technical requirements (user stories, acceptance criteria, data specs) that drive timely, high-quality delivery.

REQUIRED QUALIFICATIONS

• Minimum of ten (10) years delivering healthcare payment integrity solutions with expert-level experience in Data Mining, COB, and Code Editing across pre- and post-pay
• Minimum of ten (10) years leading production teams and process engineering; proven record running complex operations with SLAs
• Demonstrated success driving innovation and growth while managing day-to-day execution as a direct contributor and leader
• Strong independent technical skills: advanced SQL; comfort with BI/analytics; ability to translate business requirements into technical specifications; understanding of relational models, APIs, and data pipelines
• Fluency collaborating across engineering, data science, product, clinical, and executive stakeholders; excellent facilitation and communication
• Strong project/program management (Agile/Lean/RAID), process improvement, and analytics mindset; proficiency with MS Office and executive presentations
• Composure under pressure; clear decision-making in roles impacting revenue and client satisfaction
• Solving and prioritization in fast-moving, deadline-driven environments
• Excellent written and verbal communication skills; demonstrated ability to teach, coach, and develop training conten.
• Proficiency with Microsoft Office (Word, Excel, PowerPoint)
• Travel approximately 20%, with ability to travel internationally

PREFERRED QUALIFICATIONS

• Strong Excel skills (pivot tables, lookups, basic formulas) for sampling and performance tracking; familiarity with PowerPoint for polished readouts
• Exposure to process improvement and change management methodologies
• Proven experience implementing new customers into production—leading end-to-end launches from discovery and requirements through integration (SFTP/API), data validation, UAT, training, cutover, and hyper care; achieving day-1 SLA/KPI readiness
• Enterprise delivery credentials: PMP/SAFe (SPC/Agilist), Prosci change management, Lean Six Sigma Black Belt

***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.