LCD Policy Specialist

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 LCD Policy Specialist is an integral to the success of the LCD offering of Lyric. This client facing role serves as a subject matter expert on both Lyric’s LCD/NCD products and CMS LCD policy language. This important role provides clinical expertise and insight to Lyric’s LCD/NCD clients.

ESSENTIAL JOB RESPONSIBILITIES & KEY PERFORMANCE OUTCOMES

• Possesses a strong working knowledge of CMS LCDs, including structure, terminology, coverage criteria, limitations, and documentation requirements.
• Leads client-facing discussions, serving as subject matter expert explaining LCD-driven edit logic, rationale and expected outcomes to organizations that utilize Lyric’s LCD edits for pre-payment editing.
• Develops a working understanding of Lyric’s product behavior to explain and troubleshoot edit outcomes (e.g., triggers, rule logic, configuration dependencies).
• Reviews data analytics to assess impacts to content changes and new CPT/HCPCS/ICD10CM code set updates.
• Supports client escalations related to LCD edits, including analysis of scenarios and articulation of recommended resolution paths.
• Ensures alignment with relevant CMS regulations and interpretive guidance affecting LCD enforcement and claims editing.

REQUIRED QUALIFICATIONS

Required (quantifiable from resume/application):

• Education: Bachelor’s degree in health information management, Nursing or other Healthcare related degree required.
• American Academy of Professional Coders (AAPC) Certified Professional Coders (CPC) certification or American Health Information Management Association (AHIMA) Certified Coding Specialist-Physician (CCS-P) or Certified Coding Specialist (CCS) is required.
• Minimum of twelve (12) years or more relevant healthcare experience, with at least three (3) years health insurance payer experience as a payment/reimbursement or medical policy analyst, medical claims processor, chart reviewer/auditor, or clinical editing analyst.

PREFERRED QUALIFICATIONS

• Master’s degree in business or healthcare related field
• Previous ClaimsXten experience is strongly preferred
• Previous experience as a medical coder
• Previous experience at CMS (Medicare or Medicaid) or at a Health Insurance plan
• Working knowledge of pre-payment editing, payment policies and payment integrity is required.
• Must be initiative-taking and self-directed, with the ability to work independently, with minimal direction.
• Extensive demonstrated understanding of US health insurance payers including Commercial, Medicare, Medicaid (FFS and MCOs), third-party claims processing (including paper & EDI processes), medical coding, and medical billing.
• Strong communication skills: Must be an expert at presenting extraordinarily complex material via all mediums.
• Analytical skills: Candidate must possess the ability to analyze complex data, identify trends and assess potential vulnerabilities.
• Superior critical thinking skills
• Proficiency in Microsoft applications.

***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.