Remote Clinical Policy & Payments Analyst

Lyric

Augusta (ME)

Remote

USD 85,000 - 125,000

Full time

2 days ago

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Job summary

Lyric is seeking a Clinical Analyst to support development of clinical policies and payment solutions for fast, accurate coverage decisions. The role centers on clinical content, data assets, and deep understanding of diagnostic testing, payment integrity, and policy application to health plans, providers, and laboratories.

The position requires a Bachelor’s in a relevant field and 5+ years in related areas, with strong communication and analytical skills.

Qualifications

Bachelor’s degree required in biology, nursing, health sciences, or related field.
5 years’ experience in direct patient care, clinical research, utilization management, payment integrity, revenue cycle, or related areas.
Proficiency with MS Word and MS Excel; familiarity with JIRA or Monday.com or similar PM tools.
Excellent written and verbal communication skills; strong analytical abilities.
Comfort with Excel features like formulas, sorting, filtering, and pivot tables; willingness to learn.

Responsibilities

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