Remote Clinical Policy & Claims Analytics Analyst

Lyric; Topeka (KS); Remote; USD 90,000 - 120,000; Full time

Job summary

Lyric, a leader in healthcare decision intelligence, seeks a Clinical Analyst to support clinical policies and payment solutions for fast, accurate coverage decisions. You will interpret diagnostic testing insights, IT data, and payment rules to drive automation and transparency for health plans and providers.

The role requires a biology/health sciences background with at least 5 years in related clinical or payment domains, strong Excel skills, and excellent communication.

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, or related fields.
• Experience with MS Word, MS Excel, and project management tools (JIRA or Monday.com).
• Excellent written and verbal communication skills across internal and external stakeholders.
• Strong analytical skills and ability to work with qualitative and quantitative data.
• Comfort with Excel features like formulas, sorting, filtering, and pivot tables.

Responsibilities

• Apply claims analytics to identify coverage criteria and claim edit opportunities.
• Evaluate medical literature to support evidence-based policy.
• 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 with operations teams as needed.

Skills

MS Excel

Word processing

JIRA / Monday.com

Communication

Analytical skills

Pivot tables

Education

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

Job description

Lyric, a leader in healthcare decision intelligence, seeks a Clinical Analyst to support clinical policies and payment solutions for fast, accurate coverage decisions. You will interpret diagnostic testing insights, IT data, and payment rules to drive automation and transparency for health plans and providers.

The role requires a biology/health sciences background with at least 5 years in related clinical or payment domains, strong Excel skills, and excellent communication.