Lyric - Clarity in motion. · 8 hours ago
Payment Integrity Manager
United States
Full-time
Remote
Mid, Senior Level
$122K/yr - $184K/yr
5+ years expLyric is an AI-first, platform-based healthcare technology company, committed to simplifying the business of care. The Manager of Payment Integrity for Coding Review is responsible for building and operating the day-to-day Coding Review function, developing workflows, training programs, and managing the Coding Review team to ensure accurate claim review execution.
BillingConsultingConsumer SoftwareHealth CareInformation TechnologyPaymentsTransaction Processing
No H1B
Responsibilities
Develop and operate Coding Review workflows across pre-pay and post-pay programs
Perform claim review directly to support volume, validate workflows, and ensure early consistency
Oversee daily review execution, including work allocation, throughput, turnaround time, and issue resolution
Identify operational gaps and implement process improvements within established policies and procedures
Develop and maintain the Coding Review training program, including onboarding materials, reference guidance, and ongoing education
Ensure reviewers are trained to apply Coding Review guidelines consistently
Support reviewer onboarding and ongoing skill development
Develop and run the Coding Review quality assurance program, including audits, calibration, and feedback loops
Conduct quality audits and calibration activities
Monitor quality trends, identify root causes, and implement corrective actions
Serve as an escalation point for complex or ambiguous reviews
Support guideline clarification and workflow validation through direct review experience
Build and manage the Coding Review team, including hiring, onboarding, coaching, and performance management
Provide day-to-day guidance to reviewers within established company policies and processes
Develop detailed work plans and timelines to meet operational objectives
Provide execution level operational and clinical support during Coding Review implementations
Respond to customer questions related to review workflows, guideline application, and quality processes
Support customer confidence by clearly explaining Coding Review execution and quality processes
Qualification
Required
Active, unrestricted Registered Nurse license
Bachelor's degree or equivalent experience
Three or more years of clinical experience in an acute, ambulatory, or procedural care setting, with the ability to apply clinical judgment to coding and documentation review
Five or more years of experience in healthcare payment integrity, clinical coding review, auditing, or related functions
Demonstrated experience leading, coaching, and developing clinical or coding review staff, including direct people management responsibility
Proven ability to set performance expectations, provide ongoing feedback, and address performance issues within a production environment
Demonstrated hands-on claim review experience, including complex or ambiguous scenarios
Strong knowledge of professional, facility, and ancillary coding methodologies, payment policy interpretation, and clinical documentation standards
Experience developing and delivering training or onboarding programs for review staff
Ability to travel up to 20 percent, including internationally
Preferred
Advanced degree in nursing, health information management, or a related field
Advanced education or demonstrated expertise in adult learning, clinical education, or instructional design
Experience designing and delivering structured training programs or onboarding curricula at scale
Experience building, stabilizing, or scaling an operational review program or workflow
Familiarity with quality assurance sampling methodologies and inter-rater reliability concepts
Experience leading teams through operational change, process evolution, or program build out
Familiarity with AI enabled tools, automation, or decision support systems used in coding review, audit selection, or quality assurance
Comfort using operational and quality data to identify trends, measure performance, and drive continuous improvement
Company
Lyric - Clarity in motion.
Lyric is the payment integrity Al company trusted by the nation's leading health plans at the beginning of the claims payment workflow.
501-1000 employees
Funding
Current Stage
Late StageTotal Funding
$90.9M2023-08-18Undisclosed· $90.9M
2022-04-25Acquired
Leadership Team
Halsey Wise
Member Board of Directors
Meera Atkins
Chief Medical Officer
Recent News
2025-08-07
2025-08-06
2025-08-06
Company data provided by crunchbase