Medical Policy and Publication Specialist

Avalon Healthcare Solutions, headquartered in Tampa, Florida, is the world's first and only Lab Insights company, bringing together our proven Lab Benefit Management solutions, lab science expertise, digitized lab values, and proprietary analytics to help healthcare insurers proactively inform appropriate care, reduce costs, and improve clinical outcomes. Working with health plans across the country, the company covers more than 36 million lives and delivers 7-12% outpatient lab benefit savings. Avalon is pioneering a new era of value-driven care with its Lab Insights Platform that captures, digitizes, and analyzes lab results in real time to provide actionable insights for earlier disease detection, ensuring appropriate treatment protocols, and driving down overall cost.

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.

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. 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 information about Avalon, please visit www.avalonhcs.com.

Avalon Healthcare Solutions is proud to be an equal opportunity employer including disability/veteran. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.

Avalon Healthcare Solutions provides and maintains a drug-free workplace for its employees.

For more about Avalon, please visit our web site at http://www.avalonhcs.com.

About the Medical Policy and Publication Specialist position:

The Medical Policy and Publication Specialist team member is part of the Policy Operations and Enforcement Team reporting directly to the Policy and Publication Manager. The Medical Policy and Publication Specialist is responsible for managing the distribution and publication of medical policies, including formatting, editing, and ensuring accuracy and clarity of information by collaborating with internal stakeholders to align Policy Operations and Enforcement updates with client medical policy requirements.

This position is eligible for remote work, but quarterly travel to the corporate office in Tampa, Florida is required.

Medical Policy and Publication Specialist – Essential Functions and Responsibilities:

• Collaborate with internal stakeholders supporting quarterly medical policy maintenance activities.


• Edit and proofread revised client medical policies to ensure accuracy and consistency of prior/current client policy language/decisions.


• Communicate medical policy updates clearly to clients and respond to inquiries regarding medical policy interpretation and implementation.


• Manage the publication process, including uploading content to online platforms.


• Collaborate with cross-functional teams to align client decisions with coding, translation and configurational requirements.


• Collaborate with other departments to proactively seek client medical policy decisions.


• Collaborate with Implementation Team by facilitating medical policy reconciliation meetings with new clients. Traveling to client location required.


• Remote workers are required to travel to Avalon's Tampa office for quarterly in-person meetings when scheduled.


• Engagement in the creation and transition of IT ticketing system to support transitioning workflow.


• Maintain and update data resources to ensure accurate and reliable reporting.

Medical Policy and Publication Specialist – Minimum Qualifications:

• Minimum 1-3 years of relevant work experience.


• Bachelor's Degree or equivalent work experience.


• Experience creating/revising policies, standard operating procedures and/or guidelines within a managed care organization or similar health care environment.


• Understand and experience working with CPT codes and diagnosis codes.


• Understand process improvement principles.


• Outstanding written and verbal communication skills.


• Proficient computer skills (Excel, Word, Power Point, Jira, PDF creation).


• Strong organization skills and ability to prioritize and manage multiple projects.


• Flexible 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.

Medical Policy and Publication Specialist – Preferred Qualifications:

• Previous health plan experience desired.


• Experience with medical terminology (CPT code and diagnosis codes).


• Previous experience working in a start-up or early-stage company is helpful.

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