Senior Medical Director - Claims

The Senior Medical Director serves as a pivotal clinical leader within Lyric, providing strategic oversight for the development, validation, and continuous improvement of pre-payment edits to ensure robust payment integrity. In this capacity, the Senior Medical Director partners with executive leadership, clinical teams, and external stakeholders, acting as a trusted advisor on complex clinical scenarios and claims outcomes. As the primary liaison between Lyric and its customers, this role represents the organization in industry forums and payer-provider collaborations, fostering strong relationships and advancing Lyric’s reputation as an industry leader. The Senior Medical Director is also responsible for remaining at the forefront of evolving healthcare trends, regulatory requirements, and advancements in medical practice, ensuring that Lyric’s strategies and solutions consistently reflect best practices and support organizational objectives.

Role Responsibilities: 

• 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 do not remain included Lyric content groups.
• Participates in analytic review of clinical content/rules to evaluate trends and possible content/rule development opportunities.
• Serves as 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