Senior Manager, Clinical Content Maintenance

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.

The Senior Manager, Clinical Content Maintenance will serve as a strategic partner to our clients, which include major insurance payers, while managing a team of high performing Clinical Managers and Medical Content Analysts.

In this intricate role, the Senior Clinical Manager will combine their deep knowledge of CPT, HCPCS, and ICD10CM coding guidelines with strong leadership skills to guide their team in delivering superior claims edits. The Senior Manager will meet regularly with clients to assist in their interpretation of Lyric’s claim edits while using our software. The Senior Manager’s insights will shape how our clients implement our coding logic and their oversight will ensure our internal team continues to exceed expectations.

ESSENTIAL JOB RESPONSIBILITIES & KEY PERFORMANCE OUTCOMES

• Mentor and development Medical Content Analysts to achieve departmental KPIs

• Serve as subject matter expert on CPT, HCPCS, ICD10CM coding and claims edit logic (including NCCI, LCDs, State Medicaid, MUEs, Lyric edits and payer medical policies)

• Provide consultative support to internal and external clients by explaining clinical content development standard operating procedures for automated edits

• Contribute constructive feedback to the creation of Lyric’s claims editing concepts

• Translate complex coding and billing concepts into clear, actionable guidance for diverse client audiences (Medical Directors, Policy Leads, etc.)

• Stay current on regulatory trends, major CPT/ICD10CM guideline changes as well as other pertinent updates to advise clients on their implications

REQUIRED QUALIFICATIONS

Required (quantifiable from resume/application):

• Bachelor’s degree in healthcare administration, Nursing, Health Information or other healthcare related degrees

• 8+ years relevant experience, with at least 3 years of experience in a health insurance payer or automated claims editing solution, as a payment, reimbursement or medical policy analyst, medical claims processor, chart auditor/reviewer, or claims edit/denial management

• 3+ years of experience managing coding, billing or claims processing professionals

• Active AAPC Certified Professional Coders (CPC) certification or American Health Information Management Association (AHIMA) Certified Coding Specialist-Physician (CCS-P)

• Working knowledge of pre-payment editing and payment integrity

• Extensive demonstrated understanding of US health insurance payers including Commercial, Medicare, Medicaid (FFS and MCOs), third-party claims processing (including paper & EDI processes), and payment/reimbursement methodologies

• Proficiency in Microsoft applications

• Proficiency in appropriate use of Artificial Intelligence applications

PREFERRED QUALIFICATIONS

• Master’s degree in business or healthcare related field

• Experience in a leadership role within a health insurance payer

• Previous ClaimsXten experience

• Must be initiative-taking and self-directed

• Effective communication skills including expert at presenting extraordinarily complex material via all mediums

• Ability to analyze complex data, identify trends, and assess potential vulnerabilities

• Superior critical thinking skills

***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.