Medicade Solutions Consultant

TBC Corporation

6d

About The Position

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 Medicaid Solution Consultant functions as a client-facing, results-driven, and innovative leader with expertise to advise health plans on policy interpretation, coding requirements, and claims editing strategies. The ideal candidate will bring deep knowledge of state Medicaid policies, medical coding standards, and claims workflows, combined with data analysis skills to support accurate and efficient claim payment decisions. This role is consultative in nature — guiding health plans in evaluating policy impacts, making editing decisions, and improving payment integrity through Lyric42. This role will collaborate closely with product owners, technology teams, sales, and client stakeholders to ensure that our products solve the right problems and converts prospective clients into customers and users of Lyric’s editing. Successful candidates will be curious, have Payment Integrity domain experience and have a passion for solving Client challenges and innovating on their behalf. Candidates must also have excellent technical skills and a desire to play a part in the rapidly evolving role of AI in healthcare.

Requirements

• 5 + Years in CPT, HCPCS, ICD-10, and revenue coding within Medicaid programs.
• 3 + Years in Medicaid fee-for-service, managed care, and waiver programs.
• 5+ years of experience in Medicaid policy, claims processing, and medical coding
• 5+ years of experience defining and scoping Payment Integrity Solutions and Services offerings for large enterprise healthcare customers

Responsibilities

• Analyze and interpret Medicaid state and federal policies to guide claims processing and payment accuracy decisions for health plan clients
• Provide subject matter expertise to increase claim accuracy
• Work with internal teams to develop customer-facing documentation for our solutions
• Provide evidence-based recommendations for new or modified edits to align with Medicaid requirements
• Serve as a solution and industry SME
• Provide customer/solution feedback to internal stakeholders
• Interface effectively with all levels of management as well as a diverse technical team
• Communicate internally with all areas of the business and externally at prospect/customer staff, managerial, and executive level
• Provide analytics to evaluate claims outcomes and support payment accuracy initiatives

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 1,001-5,000 employees