Remote Clinical Policy Analyst AI-Driven Reimbursement

Lyric

Helena (MT)

Remote

USD 80,000 - 120,000

Full time

2 days ago

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Benefits offered by this job

Remote work

Job summary

Lyric is seeking a Clinical Analyst to support development of clinical policies and payment solutions for fast, accurate coverage and reimbursement decisions. You will lead clinical content and data assets, drawing on diagnostic testing, IT, and payment integrity to drive transparency and automation for health plans, provider systems, and laboratories.

The role requires a biology/health sciences background, 5 years of related experience, and strong communication skills.

Qualifications

Bachelor’s degree in biology, nursing, health sciences, or a related field.
5 years’ experience in direct patient care or related areas.
Strong MS Word/Excel and project tooling proficiency.
Excellent verbal and written communication.

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 in collaboration with Customer Operations as needed.