Clinical Policy & Data Analytics Specialist

TBC Corporation

Nashville (TN)

On-site

USD 90,000 - 120,000

Full time

4 days ago

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Job summary

Lyric is seeking a Clinical Analyst to support development of clinical policies and payment solutions for fast, accurate coverage and reimbursement decisions. This role requires deep understanding of diagnostic testing, information technology, payment integrity, and clinical care to drive transparency and automation for health plans, provider systems, and laboratories.

The position emphasizes collaboration across teams, with responsibilities spanning evidence-based criteria, data-driven decision

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, or related areas.

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 with Customer Operations as needed.