Policy and Publication Specialist
About The Position
The Policy and Publication Specialist is part of the Policy Operations and Enforcement Team and reports directly to the Policy and Publication Manager. The role manages the distribution and publication of medical policies, including formatting and editing content and ensuring information is accurate and clear. The specialist collaborates with internal stakeholders to align Policy Operations and Enforcement updates with client medical policy requirements. The position also supports quarterly policy maintenance, client communications, cross-functional coordination, publication workflows, and data-resource maintenance. Travel to client locations is required for reconciliation meetings with new clients. Remote workers must also travel to Avalon’s Tampa office for scheduled quarterly in-person meetings.
Requirements
- At least 3 years of experience developing and managing business requirements throughout a project lifecycle.
- Experience in or knowledge of the healthcare business and customer service.
- Intermediate knowledge of Microsoft Excel and Access.
- Experience with use-case testing.
- 1–2 years of reporting experience.
- Knowledge of one or more health plan operations areas: configuration, utilization, claims processing, or reimbursement.
- Analytical and project management skills, including the ability to interpret customer business needs and translate them into application and operational requirements.
- Facilitation skills, including workgroup leadership and problem resolution across multiple groups.
- Willingness to work in various capacities and learn new skill sets.
Nice To Haves
- Intermediate knowledge of SQL is preferred.
- Experience creating or revising policies, standard operating procedures, or guidelines within a managed care organization or similar healthcare environment.
- Understanding of and experience working with CPT codes and diagnosis codes.
- Understanding of process improvement principles.
- Outstanding written and verbal communication skills.
- Proficient computer skills, including Excel, Word, PowerPoint, Jira, and PDF creation.
- Strong organizational skills and ability to prioritize and manage multiple projects.
- Flexibility and ability to learn new technologies.
- Ability to interact effectively with counterparts and assigned clients.
- Ability to interpret and synthesize complex healthcare literature and clinical information.
Responsibilities
- Collaborate with internal stakeholders on quarterly medical policy maintenance activities.
- Edit and proofread revised client medical policies to ensure accuracy and consistency with prior and current client policy language and decisions.
- Communicate medical policy updates clearly to clients and respond to inquiries about policy interpretation and implementation.
- Manage the publication process, including uploading content to online platforms.
- Coordinate with cross-functional teams to align client decisions with coding, translation, and configuration requirements.
- Work with other departments to proactively obtain client medical policy decisions.
- Facilitate medical policy reconciliation meetings with new clients in collaboration with the Implementation Team; travel to client locations as required.
- Travel to Avalon’s Tampa office for scheduled quarterly in-person meetings if working remotely.
- Participate in creating and transitioning the IT ticketing system to support workflow transitions.
- Maintain and update data resources to ensure accurate and reliable reporting.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
