Clinical Policy & Payment Insights Analyst

Lyric Ai; United States; Remoto; USD 120.000 - 150.000; Tempo pieno

Descrizione del lavoro

Lyric seeks a Clinical Analyst to support the development of clinical policies and payment solutions enabling fast, accurate coverage decisions for health plans, providers, and laboratories. The role requires deep knowledge of diagnostic testing, IT, and clinical care.

The position demands a Bachelor’s in biology/health sciences, 5+ years in related fields, strong Excel and MS Office skills, and excellent communication.

Competenze

• Bachelor's degree 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.
• Demonstrated proficiency with MS Word, MS Excel, and project management tools (JIRA or Monday.com).
• Excellent written and verbal communication enabling internal and external collaboration.
• Strong analytical skills with qualitative and quantitative data.

Mansioni

• Apply claims analytics to identify opportunities for coverage criteria and claim edit development.
• Identify and 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 written policies.
• Enter clinical content into internal tooling and databases.
• Provide clinical content support to customers in collaboration with Customer Operations as needed.

Conoscenze

Communication skills

Analytical skills

Excel proficiency

Pivot tables

Ability to learn new software

Formazione

Bachelor's degree in biology or health sciences

Master's degree in nursing/PA or similar (preferred)

Strumenti

MS Word

MS Excel

JIRA

Monday.com

Descrizione del lavoro

Lyric seeks a Clinical Analyst to support the development of clinical policies and payment solutions enabling fast, accurate coverage decisions for health plans, providers, and laboratories. The role requires deep knowledge of diagnostic testing, IT, and clinical care.

The position demands a Bachelor’s in biology/health sciences, 5+ years in related fields, strong Excel and MS Office skills, and excellent communication.