Remote Clinical Policy & Payments Analyst

Lyric; Trenton (NJ); À distance; USD 90 000 - 130 000; Plein temps

Résumé du poste

Lyric is hiring a Clinical Analyst to support development of clinical policies and payment solutions enabling fast, accurate coverage decisions. The role requires deep knowledge of diagnostic testing, information technology, and payment integrity to drive transparency and efficiency for health plans, providers, and laboratories.

The successful candidate will analyze literature, draft coverage criteria, and program denial rules while communicating findings to leadership.

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, clinical product development/program management, market access/medical science liaison, or medical writing.
• Demonstrated proficiency with MS Word and MS Excel; familiarity with JIRA or Monday.com or other PM software.
• Excellent verbal and written communication across internal and external stakeholders.
• Strong analytical skills with both qualitative and quantitative data.
• Comfort with basic Excel formulas, sorting, filtering, and pivot tables or willingness to learn.

Responsabilités

• Apply claims analytics to identify opportunities for coverage criteria and claim edit development.
• Evaluate medical literature as part of evidence-based policy development.
• Draft and maintain coverage criteria based on age, clinical presentation, and risk factors.
• Present to peers and leadership to obtain consensus on proposed criteria.
• Recommend and program rules/logic for denial of claims based on written policies.
• Enter clinical content into internal tooling and databases; provide content support to customers as needed.

Connaissances

Bachelor's degree

Clinical background

MS Excel

JIRA or Monday.com

Strong communication

Analytical skills

Pivot tables

Formation

Bachelor’s degree in biology/health sciences

Master’s degree in nursing or PA (preferred)

Outils

MS Word

MS Excel

JIRA

Monday.com

Description du poste

Lyric is hiring a Clinical Analyst to support development of clinical policies and payment solutions enabling fast, accurate coverage decisions. The role requires deep knowledge of diagnostic testing, information technology, and payment integrity to drive transparency and efficiency for health plans, providers, and laboratories.

The successful candidate will analyze literature, draft coverage criteria, and program denial rules while communicating findings to leadership.