Remote Clinical Policy Analyst

Lyric; City of Albany (NY); Remote; USD 90,000 - 130,000; Full time

Job summary

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.

Serving as a key voice for clinical content and data assets within the team, this role depends on a deep understanding of diagnostic testing, information technology, payment integrity, and clinical care to drive transparency, automation, and efficiency for health plans, provider systems, and laboratories.

Qualifications

• Bachelor’s degree in biology, nursing, health sciences, or a related field.
• 5 years’ experience in direct patient care, clinical research, utilization management, or related areas.
• Strong MS Word/Excel with ability to use pivot tables and basic formulas.
• Excellent verbal and written communication with analytical thinking.

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 age, 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.

Skills

MS Word

MS Excel

JIRA

Project management

Communication

Analytical skills

Pivot tables

Education

Bachelor's degree

Job description

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.

Serving as a key voice for clinical content and data assets within the team, this role depends on a deep understanding of diagnostic testing, information technology, payment integrity, and clinical care to drive transparency, automation, and efficiency for health plans, provider systems, and laboratories.