Clinical Policy Analyst - Claims and AI-Driven Payments

Lyric; Boise (ID); Remote; USD 90,000 - 120,000; Full time

Job summary

Lyric is seeking a Clinical Analyst to support development of clinical policies and payment solutions enabling fast, accurate coverage decisions. You will work with clinical content and data assets to drive transparency, automation, and efficiency for health plans, providers, and labs.

You will analyze claims, evaluate literature, and help program rules for denials, while collaborating across teams in a remote US setting to support impactful patient care.

Qualifications

• Bachelor’s degree in biology, nursing, health sciences, or a 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 software (JIRA or Monday.com)
• Excellent written and spoken communication
• Strong analytical skills and experience with qualitative and quantitative data

Responsibilities

• 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 characteristics such as 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 the 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

Skills

Communication skills

Analytical skills

Excel basics

Team collaboration

Agile adaptability

Education

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

Tools

MS Word

MS Excel

JIRA

Monday.com

Job description

Lyric is seeking a Clinical Analyst to support development of clinical policies and payment solutions enabling fast, accurate coverage decisions. You will work with clinical content and data assets to drive transparency, automation, and efficiency for health plans, providers, and labs.

You will analyze claims, evaluate literature, and help program rules for denials, while collaborating across teams in a remote US setting to support impactful patient care.