Manager, Policy Coding and Translation (Healthcare Plan)

Avalon Healthcare Solutions-posted about 1 year ago
Full-time • Manager
Remote • Tampa, FL
Ambulatory Health Care Services
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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 coding systems are integrated into managed care policies and that the coding team operates efficiently. The position involves collaboration with various departments to align coding with claims adjudication and policy enforcement, while also focusing on continuous process improvement and quality standards. This is a working manager role that combines leadership with individual contributor tasks, and it requires quarterly travel to the corporate office in Tampa, Florida.

  • 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.
  • Translate 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 identify opportunities for improvement.
  • Participate in design/build sessions, assessing risks and impacts on processes.
  • Continuously evaluate existing coding and policy translation processes for efficiency and quality.
  • 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.
  • Analytical and project management skills with the ability to interpret customer business needs.
  • Ability to maintain confidentiality and comply with HIPAA regulations.
  • 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.
  • Previous experience in an early-stage growth company.
  • CPC designation strongly preferred.
  • Remote work eligibility with quarterly travel to corporate office.
  • Opportunity to make a difference in a high growth company.
  • Equal opportunity employer with a commitment to diversity and inclusion.
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