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Supervisor, Policy Coding and Translation

Avalon Healthcare Solutions

Avalon Healthcare Solutions

People & HR, Operations
Posted on Thursday, August 31, 2023

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 www.avalonhcs.com.

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 http://www.avalonhcs.com.

About the Supervisor, Policy Coding and Translation:

Reporting to the Director, Policy Operations and Enforcement, the Supervisor, Policy Coding and Translation serves Avalon’s clients in translating and coding managed care policies related to laboratory services. This position is also responsible for maintaining client service level agreements (SLAs) through monitoring, analyzing, and reporting. This is a working supervisory role that combines both individual contributor work as well as people management skills.

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

Supervisor, Policy Coding and Translation - Essential Functions and Responsibilities:

  • Supports the review of each Avalon Medical Policy to identify necessary coding and enforcement updates.
  • Works closely with the Medical Policy, Configuration, Implementation, Claims Operations, and Client Success departments to ensure that the translation, coding and configuration accurately applies medical and claims payment policy in the authorization and claims payment processes.
  • Works closely with the IT department in the development of new functionality or enhancement of existing functionality of the managed care transaction system.
  • Analyzes existing policy translation and coding to identify and document opportunities for improvements.
  • Creates and modifies documentation to support policy translation and coding processes.
  • Provides expertise during the design/build sessions with proposal of the most appropriate configuration solution as well as input into evaluation of options, risk and impact on configuration processes, policies, and standards in order to support the business needs.
  • Provides expertise in the development of Avalon’s Medical Policy enforcement rules from medical and payment policies, to include rationale for interpretation, supporting evidence, and documentation

Supervisor, Policy Coding and Translation - Qualifications:

  • Bachelor’s degree in Business or related area.
  • 2 years’ experience in health care management required, ideally with a health maintenance organization or health insurance carrier.
  • 5 or more years’ experience in claims systems as related to translation and coding.
  • Analytical and project management skills, including a thorough understanding of how to interpret customer business needs and translate these into application requirements.
  • Able to make processing decisions in exceptional claim situations.
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
  • Experience working with multiple processes and serving customers.
  • Knowledge of professional operations and interdependencies with applications supporting the patient care process.
  • Proficient with Microsoft Office products including Word, PowerPoint, and Excel
  • Demonstrated experience in translating and coding policy documents with a keen eye for detail and accuracy.
  • Excellent written and verbal communication skills, with the ability to communicate complex ideas in a clear and accessible manner.
  • Ability to adapt to changing priorities, tight deadlines, and handle multiple projects simultaneously.
  • A proactive and adaptable attitude, capable of thriving in a fast-paced and dynamic work environment.

Supervisor, Policy Coding and Translation - Preferred Qualifications:

  • Previous experience in an early-stage growth company helpful.
  • CPC designation strongly preferred.