Clinical Policy & Payments Analyst - Remote

Lyric

Salem (OR)

Remoto

USD 110.000 - 170.000

Tempo pieno

5 giorni fa

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Descrizione del lavoro

Lyric is seeking a Clinical Analyst to support development of clinical policies and payment solutions for fast, accurate coverage and reimbursement decisions. You will be a key voice for clinical content and data assets within the team, requiring deep knowledge of diagnostic testing, IT, payment integrity, and clinical care to drive transparency and automation for health plans and laboratories.

Join Lyric to help shape evidence-based criteria, collaborate with cross-functional teams, and

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, or related areas.
Proficiency with MS Word, MS Excel, JIRA or Monday.com, or other PM software.
Excellent communication skills (verbal and written).

Mansioni

Apply claims analytics to identify opportunities for coverage criteria and claim edits.
Identify and critically evaluate medical literature for 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 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.