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Medical Coding and Customer Success Analyst

3 months ago

Tampa, United States Avalon Administrative Services, LLC dba Avalon Healthcare Solutions Full time

Avalon Healthcare Solutions, headquartered in Tampa, Florida, is the world's first and only Lab Insights company, bringing together our proven Lab Benefit Management solutions, lab science expertise, digitized lab values, and proprietary analytics to help healthcare insurers proactively inform appropriate care, reduce costs, and improve clinical outcomes. Working with health plans across the country, the company covers more than 36 million lives and delivers 7-12% outpatient lab benefit savings. Avalon is pioneering a new era of value-driven care with its Lab Insights Platform that captures, digitizes, and analyzes lab results in real time to provide actionable insights for earlier disease detection, ensuring appropriate treatment protocols, and driving down overall cost.

Studies show that 30% of clinical laboratory testing is unnecessary or overused. Inappropriate testing or missing a key screening can lead to complications and expense arising from unwarranted care, or not obtaining proper care when needed, leading to increased health risks and costs. Avalon helps ensure delivery of the right test, at the right time, and in the right setting. We seek to ensure the most effective patient treatment, improve clinical outcomes, and optimize cost and affordability.

Avalon is a portfolio company of Francisco Partners, a global private equity firm that specializes in investments in technology and technology-enabled service companies.

Avalon is a high growth company where every associate has an opportunity to make a difference. You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve.

For more information about Avalon, please visit .

Avalon Healthcare Solutions is proud to be an equal opportunity employer including disability/veteran. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.

Avalon Healthcare Solutions provides and maintains a drug-free workplace for its employees.

For more about Avalon, please visit our web site at .

About the Medical Coding and Customer Success Operations Analyst:

The Customer Success Operations Analyst (CSOA) will be a part of the Network Claims Operations Department but will also provide inter-department support. Responsibilities will include claims coding and editing investigation, communicating relevant claims decisioning and impact analysis to providers and health plan clients via ticket submissions or other mechanisms. Additionally, the Customer Success Operations Analyst collects data from clients and claims to determine trends, provide feedback and work with management to create business process. This individual is expected to work collaboratively with other departments as well as understanding the processes within their own departments to assist clients with questions and triage information within the organization.

This position is eligible for remote work, but quarterly travel to the corporate office in Tampa, Florida will be required.

Medical Coding and Customer Success Operations - Essential Functions and Responsibilities:

  • Acts as the Operational Subject Matter experts for client engagement
  • Develop and provide customer and provider education as needed.
  • Evaluate disputed claims in denial management process for system configuration, claims processing, and/or contractual issues to facilitate Health plan review of claims.
  • Track client and provider issues and monitor trends to support their resolution.
  • Schedule meetings with clients or providers as required to resolve issues or provide education.
  • Effectively and accurately communicates client needs and advocates on their behalf.
  • Collects data from clients relating to claims and escalate to management.
  • Develop, run, and execute client queries and or internal reports.
  • Responds to provider and client ticket requests within established turnaround times.
  • Makes regular status updates to tickets.
  • Provides excellent customer service to clients.
  • Understands Business Needs and Business Process
  • Understand Department needs and recommends resources for process improvements.
  • Collaborates with other departments to support client needs.
  • Assists with special assignments and projects that require extensive and thorough research.
  • Performs other duties as assigned.
  • To provide analysis and facilitation of issue resolution for our health plan clients.
  • Deliver timely analysis of claims in response to providers.
  • Storing and maintenance of multiple electronic documents.
  • Acquire an in depth-understanding of internal processes in order to effectively and efficiently resolve customer inquiries.
  • Delivery of monthly reports to various clients.

Medical Coding and Customer Success Operations - Qualifications:

  • Bachelor's Degree or minimum of 3 years related work experience in a similar role.
  • Minimum 3 years' experience working in the health insurance industry.
  • 3 years medical, billing and coding required
  • Certified professional coder certification preferred.
  • Some understanding of health insurance claims and terminology.
  • Intermediate SQL experience.
  • Basic knowledge of Microsoft Office Suite products
  • Strong Customer service skills
  • Experience with client and customer interactions and fostering strong relationships.
  • Exceptional communication skills with a focus on quality and high attention to detail.
  • Exceptional interpersonal skills with demonstrated ability to work independently as well as with a team.
  • Strong organizational skills
  • Willingness to learn new skills and ability to multi-task.
  • Demonstrate ability to problem solve and utilize analysis, experience, and judgement to make accurate decisions.
  • Excellent analytical skills and the ability to process complex data.
  • Ability to manage multiple priorities and projects in a fast-paced environment.
  • Is driven and has a can-do attitude.

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