Avalon Healthcare Solutions · 2 days ago
Policy Coding and Enforcement Analyst
US
Full-time
Hybrid
Mid LevelAvalon Healthcare Solutions is the world's first and only Lab Insights company, and they are seeking a Policy Coding and Enforcement Analyst to ensure proper coding and translation of medical policies into enforcement rules. The role involves reviewing medical policies, applying coding, and developing enforcement rules to support the company's mission of improving clinical outcomes and healthcare affordability.
AnalyticsHealth CareHospitalMedical
Responsibilities
Review each Avalon Medical Policy to identify necessary coding and enforcement updates
Application of proper ICD-10, CPT, and HCPCS coding to Avalon Medical Policies
Develop Avalon Medical Policy enforcement rules, to include rationale for interpretation, supporting evidence, and documentation, from Avalon Medical and Payment Policies
Identify and record coding and enforcement changes for each policy
Coding and enforcement analysis and research as needed
Qualification
Required
Bachelor degree or equivalent related work experience
Biology, chemistry, medicine, nursing, medical technology, or related 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 proper documentation
Strong understanding of laboratory billing and reimbursement practices
Strong verbal and written communication skills with the ability to simply convey complex subject matter
Independent, capable of decision making with limited information
Preferred
Certified Medical Coder - RHIT, CPC, CCS 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 & Medicaid Services (CMS) and industry standard billing, compliance, and reimbursement methodologies
Familiarity with commercial payor medical policies
Familiarity with government programs, such as Medicare and Medicaid
Experience with data analysis tools
Company
Avalon Healthcare Solutions
Avalon is the world’s first Lab Insights company pioneering a new era of value-driven care by unlocking the potential of lab results.
Founded in 2013
51-200 employees
Funding
Current Stage
Growth StageTotal Funding
$54.27MKey Investors
Francisco Partners
2018-01-01Debt Financing· $25M
2017-02-06Series C· $29.27M
2016-01-07Series B
Leadership Team
William (Bill) Kerr
Co-Founder & CEO
Recent News
2026-01-07
2025-06-24
Company data provided by crunchbase