Medical Coding Clinical Analyst Job in Tampa, Florida

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.

About the Medical Coding Clinical Analyst Position:

The Medical Coding Clinical Analyst will accurately and comprehensively identify appropriate ICD, CPT, and/or HCPCS codes that correspond to Avalon medical policies. The Medical Policy Coder will work with other members of the Clinical Operations and Medical Policy groups to help ensure Avalon’s medical policies deliver on our objectives to improve the efficiency of clinical lab testing.

This position is based in Tampa, Florida, and is not a remote role.  This is a full-time, W-2 position.  At this time, we can consider only local candidates authorized to work in the US.   No recruiter calls, please

Responsibilities of the Medical Coding Clinical Analyst Position: 

• Translate lab medical policy narrative into appropriate ICD, CPT, and/or HCPCS codes to facilitate prior authorization activity and/or appropriate system adjudication.
• Provide clinical and coding expertise in reconciling differences between Avalon and client lab medical policies.
• Liaise with various Operations team members to ensure that business rules mirror policy intent.
• Contribute content to facilitate communication with and education of the provider network and client base regarding lab medical policy.
• Identify lab claims system coding issues and assist in the formulation of system efficiency recommendations to ensure exceptions reduction through accurate coding and clinical appropriateness.
• Participate in the analysis of lab claim coding trends. Identify potential root causes of trends, and recommend changes in methods, procedures, and policies in order to improve quality and consistency with industry standard coding guidelines.

Qualifications of the Medical Coding Clinical Analyst Position: 

• At least five years of medical or lab coding experience with strong knowledge of and experience with CMS coding and reimbursement rules and industry standard claims editing software.
• Active RN license.
• Previous employment by a health plan or lab provider in which knowledge of diagnostic and procedural coding practices was frequently accessed.
• Experience with Centers for Medicare & Medicaid Services (CMS) and industry standard billing, compliance, and reimbursement methodologies.
• Knowledge of and experience with laboratory medical coding rules and regulations, compliance, reimbursement, bundling issues.
• Certified Coding Specialist, Physician-Based (CCS-P).
• Inpatient/outpatient laboratory coding experience highly desired.
• Previous experience in a start-up or early-stage company.