Clinical Analyst

TBC Corporation • Remote - Tennessee, TN

7d

About The Position

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. The role serves as a key voice for clinical content and data assets within the team and draws on knowledge of diagnostic testing, information technology, payment integrity, and clinical care to promote transparency, automation, and efficiency for health plans, provider systems, and laboratories.

The position involves applying claims analytics to identify coverage criteria and claim-edit opportunities; evaluating medical literature and developing evidence-based policies; and drafting, reviewing, and maintaining coverage criteria. The Clinical Analyst presents proposed criteria to peers and leadership, recommends and programs claim-denial rules and logic based on written policies, enters clinical content into internal tools and databases, and supports customers in collaboration with Customer Operations as needed.

Applicants must already be legally authorized to work in the United States. Visa sponsorship and other immigration support are not available. The posting describes this as a full-time position. The U.S. base salary range is not provided; compensation may depend on factors including relevant experience, education, and work location.

Requirements

• Bachelor’s degree in biology, nursing, health sciences, or a related field.
• Five years of experience in direct patient care, clinical research, utilization management, payment integrity, revenue cycle management, clinical product development or program management, market access or medical science liaison work, or medical writing.
• Demonstrated technological proficiency and experience with software applications, including MS Word, MS Excel, and JIRA, Monday.com, or other project management software.
• Excellent verbal and written communication skills for effective communication internally across 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.

Nice To Haves

• Master’s degree in nursing, Physician Associate (PA), or a similar field.
• Radiology technician, radiology technologist, or radiologist assistant certification.
• Familiarity with claims data, procedure codes, and ICD-10-CM codes.
• Comfort working in agile, fast-paced, and collaborative environments.
• Willingness to use AI programs and participate in developing AI solutions.
• Engaged, self-motivated, and proactive, with the ability to work with a moderate degree of independence.
• Growth mindset and lifelong-learning approach to work.

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 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 or logic for denying claims based on 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.

What This Job Offers

• Job Type: Full-time