Policy Coding and Translation Expert
4 days ago
Avalon Administrative Services, LLC dba Avalon Healthcare Solutions is a dynamic organization that pioneers value-driven care through its Lab Insights Platform.
As a leading Lab Insights company, we deliver 7-12% outpatient lab benefit savings to healthcare insurers across the country, covering more than 36 million lives. Our mission is to ensure the delivery of the right test, at the right time, and in the right setting, ultimately improving clinical outcomes and health care affordability.
We are seeking an exceptional Manager, Policy Coding and Translation to join our team. This critical role will oversee the development, maintenance, and implementation of coding processes for laboratory and clinical policies, ensuring seamless updates to PLA, AMA HCPCS, and ICD-10 codes.
The ideal candidate will possess analytical and project management skills, with a proven ability to interpret customer business needs and translate them into application requirements. Experience working with multiple processes and serving customers is essential, along with knowledge of professional operations and interdependencies with applications supporting the patient care process.
This position requires excellent written and verbal communication skills, with the ability to communicate complex ideas in a clear and accessible manner. The successful candidate will be able to adapt to changing priorities, tight deadlines, and handle multiple projects simultaneously, thriving in a fast-paced and dynamic work environment.
Key Responsibilities:
- Develops and maintains controlled documentation for coding and translation of laboratory and clinical policies.
- Integrates annual updates for PLA, AMA HCPCS, and ICD-10 codes into policies.
- Contributes to the development and enforcement of medical policy rules, including rationale, evidence, and documentation for interpretation and implementation.
- Provides expertise in translating medical and payment policies into actionable claims adjudication logic, ensuring all updates are integrated seamlessly.
What We Offer:
A competitive salary of $120,000 - $150,000 per annum, commensurate with experience, plus a comprehensive benefits package, including health insurance, retirement plan, and paid time off. This is a remote-friendly role, with quarterly travel to our corporate office in Tampa, Florida required.
We are an equal opportunity employer, committed to diversity and inclusion. If you are a motivated and detail-oriented individual with a passion for policy coding and translation, please apply for this exciting opportunity to make a difference in the lives of millions.
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