Remote Clinical Policy & Coverage Analyst

Lyric; San Juan (PR); Remoto; USD 90.000 - 130.000; Tempo pieno

Descrizione del lavoro

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. This role requires deep understanding of diagnostic testing, information technology, payment integrity, and clinical care to drive transparency and automation.

The position emphasizes evaluating literature, drafting coverage criteria, and programming denial rules, with remote-US work and full-time commitment.

Competenze

• 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.
• Proficiency with MS Word, MS Excel, and JIRA or Monday.com or similar PM software
• Excellent communication skills (verbal and written) enabling effective communication both internally with all areas of the business and externally
• Strong analytical skills, including analysis of qualitative and quantitative information
• Comfort with basic formulas, sorting, filtering, and pivot tables in Excel and similar applications, or willingness to learn

Mansioni

• 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

Conoscenze

Excellent communication skills

Strong analytical skills

Pivot tables in Excel

Formazione

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

Strumenti

MS Word

MS Excel

JIRA

Monday.com

Descrizione del lavoro

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. This role requires deep understanding of diagnostic testing, information technology, payment integrity, and clinical care to drive transparency and automation.

The position emphasizes evaluating literature, drafting coverage criteria, and programming denial rules, with remote-US work and full-time commitment.