Payment Integrity Manager

TBC Corporation

2d

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 Manager of Payment Integrity for Coding Review is responsible for building and operating the day-to-day Coding Review function at Lyric. This role develops and runs Coding Review workflows, establishes training and quality frameworks, and manages the Coding Review team to ensure accurate, consistent, and scalable claim review execution. This role is hands on, particularly during early program build out, and includes direct claim review, guideline interpretation, training development, and quality assurance execution. The Manager also provides execution level support for Coding Review implementations and customer questions, operates within established Coding Review direction, and ensures leadership decisions are implemented through disciplined execution.

Requirements

• 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

Nice To Haves

• 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

Responsibilities

• Coding Review Operations and Workflow Execution 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
• Training Program Development and Reviewer Readiness 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
• Quality Assurance and Consistency Oversight 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
• Hands On Clinical and Coding Review Support Serve as an escalation point for complex or ambiguous reviews
• Support guideline clarification and workflow validation through direct review experience
• Team Leadership and Day to Day Management 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
• Customer Support and Implementation Assistance 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

Benefits

• Lyric is an Equal Opportunity Employer that strives to create an inclusive environment, empower employees and embrace collaborative success.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level