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