Remote Clinical Policy & Claims Analyst

Lyric

Cheyenne (WY)

Remote

USD 90,000 - 135,000

Full time

2 days ago

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Job summary

Lyric is a healthcare decision intelligence leader seeking a Clinical Analyst to support development of clinical policies and payment solutions for fast, accurate coverage and reimbursement decisions. You will help define criteria, evaluate literature, and program rules for claim denials while contributing to internal data assets and tooling.

Ideal candidates hold a biology/health sciences background with 5+ years in related roles, strong Excel and PM tool proficiency, and excellent

Qualifications

Bachelor’s degree in biology, nursing, health sciences, or related field is required.
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; JIRA or Monday.com or other PM software.
Excellent communication skills (verbal and written) for internal/external stakeholders.
Strong analytical skills with both qualitative and quantitative data evaluation.
Comfort with basic Excel formulas, sorting, filtering, and pivot tables; willingness to learn.

Responsibilities

Apply claims analytics to identify opportunities for coverage criteria and claim edit development.
Evaluate medical literature for evidence-based policy development.
Draft and maintain coverage criteria based on age, presentation, and risk factors.
Present findings to peers and leadership to reach consensus on criteria.
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.