Healthcare Policy Ideation Lead

Lyric, formerly ClaimsXten, is a leading healthcare technology company, committed to simplifying the business of care. Over 30 years of experience, dedicated teams, and top technology help deliver more than $14 billion of annual savings to our many loyal and valued customers—including 9 of the top 10 payers across the country. Lyric’s solutions leverage the power of machine learning, AI, and predictive analytics to empower health plan payers with pathways to increased accuracy and efficiency, while maximizing value and savings. Lyric’s strong relationships as a trusted ally to customers resulted in recognition from KLAS as “true partner” and “excellent value for investment,” with a top score for overall customer satisfaction and A+ likelihood to recommend in their October 2023 Payment Integrity and Accuracy Report. Discover more at Lyric.ai. 

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 Healthcare Policy Ideation Lead is responsible for understanding key healthcare issues, payer challenges, industry rules and regulations as well as competitive product offerings. This role will identify patterns across data, and research industry trends to inform innovative solutions. In addition, the Healthcare Policy Ideation Lead will evaluate and re-purpose existing content across the portfolio and adjacent markets.

ESSENTIAL JOB RESPONSIBILITIES & KEY PERFORMANCE OUTCOMES

• Drive Growth & Differentiation - Identify market growth drivers and develop innovative content, solutions, and service models to meet payer needs and create competitive advantage.
• Research & Market Intelligence - Monitor clinical, coding, regulatory, and AI trends to translate emerging insights into actionable content strategy and product opportunities.
• Cross-Functional Collaboration - Partner with Product Strategy, Clinical Operations, Clinical Networks, and clients to surface high-impact opportunities and guide innovation priorities.
• Content Quality & Expansion - Conduct research on payer behavior; identify and evaluate new data sources to expand and enhance the quality of PI content.
• Ideation & Content Strategy - Lead and participate in ideation and discovery sessions with internal stakeholders and customers to assess market demand and shape new program concepts.
• Sourcing & Innovation Models - Support build, buy, or partner decisions to source clinical content and develop scalable, differentiated programs.

Collaborate with Product teams to assess feasibility, define requirements, and prioritize capabilities for go-to-market execution.

REQUIRED QUALIFICATIONS

• Bachelor's degree in business or healthcare/related field or at least 10 years in a directly related role.
• Minimum of (5) years of experience working with medical billing, claim processing, coding, claim and reimbursement methodologies, documentation interpretation, payment policy or working with medical claims to identify improper payments as a payment integrity vendor or within a health plan’s payment integrity team.
• Minimum of (5) years of experience understanding payment integrity principles, including prepayment and post-payment workflows, applications and service components as well as an understanding of medical terminology, CMS, Medicaid/Medicare regulations.
• Minimum of five (5) years of ideation experience performing and interpreting analysis to drive data-informed decisions.
• Experience working with or managing AI-enabled products, especially those involving medical claims, coding, or clinical text analysis.
• Must be current on healthcare AI trends and regulatory shifts, using that insight to influence roadmap.
• Experience in clinical research, policy surveillance, or market analysis related to payment integrity or coding.
• Skill in synthesizing payer policy, clinical evidence, and coding guidelines to support the development of defensible and impactful content.

PREFERRED QUALIFICATIONS

• Active applicable related certificate or license (CCS, CCS-P, CPC, RHIA)
• Prior work in health insurance, claims processing or adjudication, or fraud, waste and abuse detection.
• Expertise in researching highly technical information on the internet
• Experience with medical coding sources such as CPT Assistant, medical association publications supporting medical coding and clinical research websites
• Extensive knowledge of claims data and associated industry-standard codes such as CPT, ICD diagnosis, revenue, bill type and admit/discharge status codes
• Experience leading working groups and internal and external cross-functional discussions.

***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.