Clinical Policy & Claims Analytics Specialist - Remote

Lyric; Salt Lake City (UT); 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.

You will serve as a key voice for clinical content and data assets within the team, leveraging expertise in diagnostic testing, IT, payment integrity, and clinical care to drive transparency and automation for health plans, provider systems, and laboratories.

Qualifikationen

• 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 tools (e.g., JIRA or Monday.com).
• Excellent verbal and written communication for internal and external stakeholders.
• Strong analytical skills with ability to analyze qualitative and quantitative data.
• Familiarity with Excel features like formulas, sorting, filtering, and pivot tables.

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 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

Kenntnisse

Communication skills

Analytical skills

Excel basics

Ausbildung

Bachelor’s degree in biology, nursing, health sciences, or a 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.

You will serve as a key voice for clinical content and data assets within the team, leveraging expertise in diagnostic testing, IT, payment integrity, and clinical care to drive transparency and automation for health plans, provider systems, and laboratories.