Clinical Policy Analyst - AI-Driven Payment Insights

Lyric; Lincoln (NE); Remote; USD 90.000 - 120.000; Vollzeit

Zusammenfassung

Lyric is seeking a Clinical Analyst to support the development of clinical policies and payment solutions that enable fast, accurate, and intelligent coverage and reimbursement decisions. This role requires deep understanding of diagnostic testing, IT, payment integrity, and clinical care to drive transparency and automation for health plans, providers, and laboratories.

The analyst will work on applying claims analytics, evaluating literature, drafting coverage criteria, and presenting findings

Qualifikationen

• Bachelor’s degree required in biology, nursing, health sciences, or related field.
• 5 years’ experience in direct patient care, clinical research, utilization management, payment integrity, revenue cycle management, clinical product development/program management, market access/medical science liaison, or medical writing.
• Proficiency with MS Word, MS Excel, and project management tools such as JIRA or Monday.com.

Aufgaben

• Apply claims analytics to identify opportunities for coverage criteria and claim edit development.
• Identify and critically evaluate medical literature as part of evidence-based policy development.
• Draft, review, and maintain coverage criteria based on age, clinical presentation, and risk factors.
• Provide written and oral presentations to peers and leadership to obtain consensus on proposed criteria.
• Recommend and program rules/logic for denial of claims based on criteria in written policies.
• Enter clinical content into internal tooling and databases.
• Provide clinical content support to customers in collaboration with Customer Operations as needed.

Kenntnisse

Excellent communication

Strong analytical skills

Comfort with Excel formulas

Ausbildung

Bachelor’s degree in biology, nursing, health sciences, or related field

Tools

MS Word

MS Excel

JIRA / Monday.com

Jobbeschreibung

Lyric is seeking a Clinical Analyst to support the development of clinical policies and payment solutions that enable fast, accurate, and intelligent coverage and reimbursement decisions. This role requires deep understanding of diagnostic testing, IT, payment integrity, and clinical care to drive transparency and automation for health plans, providers, and laboratories.

The analyst will work on applying claims analytics, evaluating literature, drafting coverage criteria, and presenting findings