Remote Clinical Policy & Analytics Specialist

Lyric; Juneau (AK); 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 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.
• Proficiency with MS Word, MS Excel, and JIRA or Monday.com.
• Excellent verbal and written communication skills.
• Strong analytical skills with experience in sorting, filtering, and pivot tables in Excel.

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, 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

Clinical experience

Patient care

Clinical research

Utilization management

Payment integrity

Revenue cycle

Product development

Market access

Medical writing

MS Word

MS Excel

JIRA

Monday.com

Education

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

Master’s degree in nursing, PA, or similar

Tools

MS Word

MS Excel

JIRA

Monday.com

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.