Payment Integrity, New Opportunity Consultant

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.

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.

By researching industry and governmental references, specialty society guidance, industry trends and paid claims data, the New Opportunity Consultant identifies areas where claim overpayments may occur. This team member recommends solutions to limit and reduce claim overpayments. This position is instrumental in the support of Lyric clients to find new savings opportunities.

ESSENTIAL JOB RESPONSIBILITIES & KEY PERFORMANCE OUTCOMES

• Recommend new proposals for pre-payment claim edits to provide clients with incremental savings.
• Analyze paid claims data for the purpose of identifying overpayments and areas for incremental savings.
• Ability to provide detailed requirements to the development team to build proposals recommended by consultant.
• Function as a Consultant to internal and external clients to introduce new concepts, estimate realistic savings, and evangelize value to ensure client adoption.
• Stay abreast of all topics relevant to coding/billing/overpayment trends, changes in coding guidelines and industry standards.
• Prepare, deliver, and provide clinical support related to clinical content to both internal and external customers.
• Serve as clinical content SME on cross-functional teams, to communicate relevant client or industry feedback to project stakeholders for product revisions and/or new functionality.

REQUIRED QUALIFICATIONS

• Education: Bachelor’s degree in healthcare information system management, Health Information Management, Nursing, or other Healthcare related degree preferred
• American Academy of Professional Coders (AAPC) Certified Professional Coders (CPC) certification or American Health Information Management Association (AHIMA) Certified Coding Specialist-Physician (CCS-P) is required prior to hire date.
• 5 years or more relevant healthcare experience as a medical coder, medical claims processor medical auditor, clinical editing analyst, or payment or medical policy analyst.

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PREFERRED QUALIFICATIONS

• Master’s degree in business or healthcare related field.
• Previous experience in physician or centralized billing office with multi-specialty practices preferred.
• Previous experience as a nurse is a plus.

• Current working knowledge of pre-payment editing and payment integrity.
• Possess expertise at communication and presenting extraordinarily complex material via all mediums.
• Must be initiative-taking and self-directed.
• Mastery of analyzing complex data analytics, identification of trends and assessment of potential overpayment vulnerabilities.
• Superior critical thinking skills
• Knowledge of healthcare reimbursement and medical policies as well as payment methodologies.
• Ability to work independently, with minimal supervision.
• Proficiency in Microsoft applications.

***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.