Lyric is an AI-first, platform-based healthcare technology company dedicated to improving payment accuracy and reducing waste in healthcare. The Payment Integrity Principal serves as a senior authority responsible for system-level payment integrity strategy, coding review logic, and enablement across the Lyric platform. This role ensures scalable, automated solutions integrating rules, workflows, analytics, and AI-driven capabilities to deliver accurate and defensible payment integrity outcomes.
The role includes oversight of program domain logic implementation, collaboration with product and engineering teams, stewardship of technical debt management, and serving as a domain expert for enterprise initiatives related to coding review.
Key responsibilities include defining rule logic and workflow orchestration, analyzing claims data for payment risk, conducting in-depth coding and reimbursement research, and translating complex coding concepts into actionable technical requirements.
This position requires a bachelor's degree in healthcare, business, or related field, professional coding credentials (CPC, CCS, CCS-P, RHIA), over 12 years in healthcare payment integrity with coding review experience, and at least 7 years designing improper payment prevention solutions. Advanced analytical, communication, and leadership skills are essential.
- Bachelor’s degree in healthcare, business, information systems, data analytics, or related field, or equivalent experience.
- Active professional credential aligned with Coding Review such as CPC, CCS, CCS-P, or RHIA.
- 12+ years progressive experience in healthcare payment integrity including coding review.
- 7+ years experience analyzing, auditing, or designing payment integrity solutions in health plan or payer-side environments.
- Proven ability to translate domain expertise into scalable logic and automation.
- Strong analytical skills with experience analyzing large claims datasets.
- Experience with AI-assisted decisioning and machine learning workflows.
- Excellent written and verbal communication skills.
- Knowledge and compliance with HIPAA and data security standards.
- Advanced proficiency in Microsoft Excel, SQL, and BI or analytics tools.
- Experience defining performance metrics and AI governance frameworks.
- Demonstrated leadership and change management capabilities.
Lyric is recognized for excellence with Best in KLAS for Pre-Payment Accuracy and Integrity and offers a collaborative, innovative work environment focused on AI-driven healthcare innovation. The company is HI-TRUST and SOC2 certified, values diversity and inclusion, and offers competitive compensation packages.
Location
N/A
Employment Type
Full-time
Experience Level
Senior
Salary Range
$125,241 - $187,862
Remote work allowed
Yes
Posted
2 weeks ago