Remote Clinical Policy & Payments Analyst

Lyric; Atlanta (GA); Remote; USD 90.000 - 120.000; Vollzeit

Zusammenfassung

Lyric is hiring a Clinical Analyst to support the development of clinical policies and payment solutions for fast, accurate coverage decisions. You will help drive transparency, automation, and efficiency across health plans, providers, and laboratories.

The role emphasizes evaluating literature, drafting coverage criteria, and programming denial rules, with a strong focus on data, IT, and agile collaboration in a remote US setting.

Qualifikationen

• 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; JIRA or Monday.com or other project management software.
• Excellent communication skills (verbal and written).
• Strong analytical skills (qualitative and quantitative).
• Comfort with basic formulas, sorting, filtering, and pivot tables in Excel.

Aufgaben

• Apply claims analytics to identify opportunities for coverage criteria and claim edit development.
• Identify and 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.

Kenntnisse

MS Excel

MS Word

JIRA

Monday.com

Project management

Communication

Analytical thinking

Pivot tables

Ausbildung

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

Master’s degree in nursing, PA, or similar

Tools

JIRA

Monday.com

MS Excel

Jobbeschreibung

Lyric is hiring a Clinical Analyst to support the development of clinical policies and payment solutions for fast, accurate coverage decisions. You will help drive transparency, automation, and efficiency across health plans, providers, and laboratories.

The role emphasizes evaluating literature, drafting coverage criteria, and programming denial rules, with a strong focus on data, IT, and agile collaboration in a remote US setting.