Remote Clinical Policy Analyst - AI-Powered Coverage

Lyric; Hagåtña (GU); Remote; USD 85,000 - 120,000; Full time

Job summary

Lyric, a leader in healthcare decision intelligence, seeks a Clinical Analyst to develop clinical policies and payment solutions for fast, accurate coverage decisions. This remote US role requires strong clinical and data skills and experience with claims analytics, evidence-based policy development, and risk-based criteria.

You will draft criteria, present findings to leadership, and program denial logic while collaborating with Customer Operations to support health plans, providers, and

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, clinical product development/program management, market access/medical science liaison, or medical writing
• Demonstrated technological proficiency with MS Word, MS Excel, and project management tools
• Excellent communication skills (verbal and written) enabling effective internal and external communication
• Strong analytical skills with qualitative and quantitative data
• Comfort with basic formulas, sorting, filtering, and pivot tables in Excel or willingness to learn

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

Skills

MS Word

MS Excel

Analytical skills

Communication skills

Verbal and written communication

Education

Bachelor’s degree in biology, nursing, health sciences, or a related field

Master’s degree in nursing or PA

Tools

JIRA or Monday.com

Job description

Lyric, a leader in healthcare decision intelligence, seeks a Clinical Analyst to develop clinical policies and payment solutions for fast, accurate coverage decisions. This remote US role requires strong clinical and data skills and experience with claims analytics, evidence-based policy development, and risk-based criteria.

You will draft criteria, present findings to leadership, and program denial logic while collaborating with Customer Operations to support health plans, providers, and