Manager, Policy Coding and Translation

Avalon Healthcare Solutions • Tampa, FL

435d • Remote

About The Position

The Manager, Policy Coding and Translation at Avalon Healthcare Solutions is responsible for overseeing the development, maintenance, and implementation of coding processes for laboratory and clinical policies. This role ensures that updates to relevant coding systems are integrated into managed care policies while managing a team that collaborates with various departments to align coding with claims adjudication and policy enforcement. The position combines leadership responsibilities with individual contributor tasks, focusing on continuous process improvement and quality assurance.

Requirements

• Bachelor's degree in Business or related area.
• 2 years' experience in health care management, ideally with a health maintenance organization or health insurance carrier.
• 5 or more years' experience in claims systems related to translation and coding.
• Strong analytical and project management skills.
• Ability to interpret customer business needs and translate them into application requirements.
• Experience making processing decisions in exceptional claim situations.
• Maintain confidentiality and comply with HIPAA regulations.
• Experience working with multiple processes and serving customers.
• Knowledge of professional operations and interdependencies with applications supporting patient care.
• Proficient with Microsoft Office products including Word, PowerPoint, and Excel.
• Demonstrated experience in translating and coding policy documents with attention to detail.
• Excellent written and verbal communication skills.
• Ability to adapt to changing priorities and handle multiple projects simultaneously.
• Proactive and adaptable attitude in a fast-paced environment.

Nice To Haves

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

Responsibilities

• Develop and maintain controlled documentation for coding and translation of laboratory and clinical policies.
• Integrate annual updates for PLA, AMA HCPCS, and ICD-10 codes into policies.
• Contribute to the development and enforcement of medical policy rules, including rationale, evidence, and documentation for interpretation and implementation.
• Provide expertise in translating medical and payment policies into actionable claims adjudication logic.
• Collaborate with Medical Policy, Configuration, Claims Operations, and Client Success departments to ensure accurate coding and configuration.
• Manage the coding and translation team, providing leadership, training, and support.
• Build and maintain infrastructure to ensure timely and accurate completion of work.
• Develop training materials to ensure work quality and analyze processes for improvement.
• Participate in design/build sessions, offering input on configuration solutions and assessing risks.
• Continuously evaluate existing coding and policy translation processes for efficiency and quality.

Benefits

• Remote work eligibility with quarterly travel to corporate office in Tampa, Florida.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree