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Lyric - Clarity in motion.

Simplifying the business of care.

Senior Medical Director – Claims

Medical DirectorMedical DirectorFull TimeRemoteSeniorTeam 201-500H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

55 days ago

Salary

$211.6K - $317.3K / year

Seniority

Senior

Postgraduate Degree10 yrs expEnglishGo

Job Description

• Assist the Clinical Development Department with pre-pay edit development, maintenance and communication of new edits (edit creation, removal, most common clinical scenarios, medical policy and medical necessity reviews, etc.) for all content areas. • Approve and provide clinical rationale, when developing editing concepts that depart from sourced material to Lyric created content edits. • Provide support to Product Strategy team regarding which edits do or don’t remain included Lyric content groups. • Participates in analytic review of clinical content/rules to evaluate trends and possible content/rule development opportunities. • Trusted advisor and industry expert responsible for understanding key healthcare issues and trends as well as competitive product offerings, translating these into new cutting-edge content solutions • Regularly interact with executives and customers as well as partner with major internal Lyric stakeholders (e.g. Customer Success, Go To Market, Client Executives, Analytics, Product Strategy, etc.) • Support any content calls with clients where medical director assistance is requested/preferred, On-site customer visits as requested • Facilitate Annual New CPT Code webinar and other ad-hoc customer webinars as necessary • Hosts bi-monthly content review call with client Medical Directors on various topics

Job Requirements

  • Board-certified physician (MD or DO) with at least 10 years of active clinical experience, preferably in Internal Medicine, Family Practice or other related disciplines
  • 3 or more years’ experience as a Medical Director for a health insurance payer
  • Deep understanding of disease processes, treatment modalities and evidence-based medicine
  • American Academy of Professional Coders (AAPC) Certified Professional Coders (CPC) certification or American Health Information Management Association (AHIMA) Certified Coding Specialist-Physician (CCS-P) is required or within 6 months of hire date
  • Familiarity with payer operations, claims adjudication, and payment integrity strategies.
  • Experience with utilization management, medical policy development, and regulatory compliance.
  • Ability to analyze complex clinical scenarios, claims data, and outcomes to inform policy and operational decisions
  • Strong critical thinking, strategic planning and problem-solving skills.
  • Proven leadership in clinical and cross-functional teams, including mentoring and guiding staff as necessary
  • Excellent verbal and written communication skills for interacting with executive
  • Ability to represent the organization in industry forums and payer-provider collaborations
  • Up-to-date understanding of healthcare regulations, payer policies and industry standards.

Benefits

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

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