Remote Clinical Policy & Analytics Analyst

Lyric

Carson City (NV)

Remote

USD 90,000 - 130,000

Full time

2 days ago

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Job summary

Lyric is seeking a Clinical Analyst to support development of clinical policies and payment solutions enabling fast, accurate coverage decisions. The role requires expertise in diagnostic testing, IT, payment integrity, and clinical care to drive transparency and automation for health plans, providers, and laboratories.

Applicants must be legally authorized to work in the U.S. and remote-US work is available.

Qualifications

Bachelor’s degree required in biology, nursing, health sciences, or related field
At least 5 years of direct patient care, clinical research, utilization management, payment integrity, revenue cycle, or related roles
Proficient with word processors and spreadsheets; experience with Jira or Monday.com or similar PM tools
Excellent verbal and written communication for internal and external stakeholders
Strong analytical skills, with the ability to analyze qualitative and quantitative data
Comfort with Excel functions (formulas, sorting, filtering, pivot tables) or willingness to learn

Responsibilities

Apply claims analytics to identify coverage criteria and claim edit opportunities
Review medical literature to support evidence-based policy development
Draft and maintain coverage criteria based on age, clinical presentation, and risk factors
Present criteria to peers/leadership to obtain consensus
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 with Customer Operations as needed