About the Company:
Avalon Healthcare Solutions, headquartered in Tampa, Florida, is a clinical services and information technology company using evidence-based medicine to develop and deploy medical policies and protocols in the high-volume, dynamic and complex diagnostic lab environment. The company manages the appropriate use of thousands of existing lab tests and researches new tests to determine efficacy and impact on patient care.
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. Since its launch 15 years ago, FP has raised approximately $10 billion and invested in more than 150 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. You’ll enjoy seeing the results of your work as we rapidly implement our plan. 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 about Avalon, please visit our web site at http://www.avalonhcs.com.
This is a full-time, W-2 position. At this time, we can consider only candidates authorized to work in the US. No sponsorship is available. No recruiter calls, please.
About the Clinical Analyst position:
The Clinical Analyst will work closely with Medical Policy and Configuration Management to ensure the proper translation of medical policies into business rules and correct implementation in the Avalon claims editor. The candidate will analyze claim data to identify areas for refinement of medical policy and associated rules. A high degree of familiarity with laboratory medicine and reimbursement is required.
Clinical Analyst – Essential Functions and Responsibilities:
- Develop business rules from medical and payment policies including rationale for interpretation, supporting evidence, and documentation
- Determine coverage overlaps with government programs
- Create test cases to ensure the proper configuration and implementation of business rules into the Avalon Claims Editor
Clinical Analyst – Minimum Qualifications:
- Bachelor of Science or Arts or equivalent
- Strong understanding of laboratory billing and reimbursement practices
- Strong verbal and written communication skills with the ability to simply convey complex subject matter
- High attention to detail and documentation
- Clinical experience with a background of ICD-10, CPT, and HCPCS coding principles
- Independent, capable of decision making with limited information
- Prefer Coding certification: RHIT, CPC, CCS or similar
Clinical Analyst – Qualifications Preferred:
- Experience with Centers for Medicare & Medicaid Services (CMS) and industry standard billing, compliance, and reimbursement methodologies.
- Familiarity with commercial payor medical policies
- Familiarity with government programs (Medicare, Medicaid, ACA Marketplace, etc.)
- Knowledge of and experience with laboratory medical coding rules and regulations, compliance, reimbursement, bundling issues.
- Certified Medical Coder
- Experience with developing logic associated claims editing
- Experience with data analysis tools
- Biology, chemistry, medicine, nursing, medical technology, or related field of education