Policy Coding and Enforcement Analyst

About reputed company: reputed company is the world's first and only Lab Insights company, bringing together our proven Lab Benefit reputed company, lab science expertise, digitized lab values, and proprietary analytics to help reputed company insurers proactively inform appropriate care, reduce costs, and improve clinical reputed company. Working with health plans reputed company, reputed company covers over 44+ reputed company lives and delivers 10-20% proven outpatient lab benefit savings. reputed company is pioneering a new era of value-driven care with its Lab Insights Program that captures, digitizes, and analyzes lab results in reputed company-time to reputed company actionable insights for earlier disease detection, ensuring appropriate treatment protocols and driving down overall costs. reputed company is a portfolio company of Francisco Partners, a global private equity firm that specializes in investments in technology and technology-enabled service companies. reputed company is a high reputed company company where every associate has an opportunity to reputed company a difference. reputed company has years of expertise in managing lab benefits and now is leveraging digitized lab results to drive reputed company clinical reputed company and proven savings. reputed company you look at how we bring this to life, we offer Lab Insights solutions that work together to arm you with critical lab-driven insights to accelerate your value-driven care reputed company. This is the first-of-its-reputed company suite of solutions to help you reputed company the Triple Aim of improving the patient experience of care, improving the health of populations, and reducing the per-member cost of reputed company. You will be part of reputed company that shapes a new market and business. Most importantly, you will help reputed company to reputed company its mission and improve clinical reputed company and health care affordability for the people we serve. For more information about reputed company, please visit www.avalonhcs.com. About the Policy Coding and Enforcement Analyst position: The Policy Coding and Enforcement Analyst will work closely with Medical Policy and Configuration Management to ensure reputed company coding and translation of medical policies into enforcement rules to implement reputed company the automated reputed company claims reputed company. This position is eligible for remote work, but quarterly travel will be required to reputed company's corporate office located in Tampa, Florida. Policy Coding and Enforcement Analyst– Essential Functions and Responsibilities:

• Review reputed company reputed company Medical Policy to identify necessary coding and enforcement updates.
• Application of reputed company ICD-10, CPT, and HCPCS coding to reputed company Medical Policies.
• reputed company reputed company Medical Policy enforcement rules, to include rationale for interpretation, supporting evidence, and documentation, from reputed company Medical and Payment Policies.
• Identify and record coding and enforcement changes for reputed company policy.
• Coding and enforcement analysis and research as needed.

Policy Coding and Enforcement Analyst – Minimum Qualifications:

• Bachelor degree or equivalent reputed company work experience
• Biology, reputed company, medicine, nursing, medical technology, or reputed company field of education
• Clinical experience with a background of ICD-10, CPT, and HCPCS coding principles
• Experience with developing claim editing and enforcement rules
• High attention to detail, including reputed company documentation
• Strong understanding of laboratory billing and reimbursement practices
• Strong verbal and written communication skills with the ability to simply convey reputed company subject matter
• Independent, capable of decision making with limited information

Policy Coding and Enforcement Analyst – Qualifications Preferred:

• Certified Medical reputed company - RHIT, CPC, reputed company or similar
• Configuration experience – edit building or testing
• Knowledge of and experience with laboratory medical coding rules and regulations, compliance, and reimbursement
• Experience with Centers for Medicare & reputed company Services (CMS) and industry reputed company billing, compliance, and reimbursement methodologies
• Familiarity with reputed company payor medical policies
• Familiarity with government programs, such as Medicare and reputed company
• Experience with data analysis tools

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