Remote Clinical Policy & Payment Analyst

Lyric; Honolulu (HI); 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 enabling fast, accurate coverage and reimbursement decisions. This role relies on deep knowledge of diagnostic testing, IT, payment integrity, and clinical care to drive transparency and efficiency for health plans, provider systems, and laboratories.

The position requires a Bachelor’s degree and 5 years’ experience in related roles, plus strong analytical and communication skills and

Qualifications

• 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.
• Demonstrated proficiency with MS Word, MS Excel, JIRA or Monday.com or other PM software.
• Excellent communication skills (verbal and written).
• Strong analytical skills with qualitative and quantitative data.
• Comfort with basic Excel formulas, sorting, filtering, and pivot tables or willingness to learn.

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, 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 analytics

Policy development

Communications

Excel basics

Education

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

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 enabling fast, accurate coverage and reimbursement decisions. This role relies on deep knowledge of diagnostic testing, IT, payment integrity, and clinical care to drive transparency and efficiency for health plans, provider systems, and laboratories.

The position requires a Bachelor’s degree and 5 years’ experience in related roles, plus strong analytical and communication skills and