Genetics Claims Editor & Policy Automation Pro

Avalon Administrative Services LLC; Tampa (FL); Remote; USD 75.000 - 98.000; Vollzeit

Zusammenfassung

Avalon Healthcare Solutions seeks a Claims Editing Content Analyst, Genetics Testing Management to design and support automated claim edits across Avalon’s programs. Initially focused on GTM, the role reviews policies with Scientific Affairs and Coding & Translation, translates opportunities into rule statements, and models financial impact using claims data and approved AI tools.

The position is designed for an early-career professional with healthcare claims experience.

Qualifikationen

• Minimum 3+ years in claims editing, payment integrity, or related field.
• Working knowledge of healthcare claims and medical coding systems.
• Ability to translate policies into clear, testable business rules.
• Experience using Excel, SQL, and BI tools to analyze claims data.

Aufgaben

• Maintain a prioritized pipeline of opportunities to enhance existing policies and develop new claim edits.
• Review policies, coding guidance, regulatory updates to identify opportunities.
• Translate policy requirements into clear, testable rule statements and configurations.
• Evaluate claim data to apply edits accurately using specified fields.
• Support rollout with training materials and client adoption.
• Monitor implemented edits and suggest improvements for accuracy and outcomes.

Kenntnisse

Claims editing

Payment integrity

Medical coding

Data analysis

SQL

Excel

Communication

Cross-functional collaboration

Ausbildung

Bachelor’s degree in a related field

Tools

Excel

SQL

BI tools

AI tools

Jobbeschreibung

Avalon Healthcare Solutions seeks a Claims Editing Content Analyst, Genetics Testing Management to design and support automated claim edits across Avalon’s programs. Initially focused on GTM, the role reviews policies with Scientific Affairs and Coding & Translation, translates opportunities into rule statements, and models financial impact using claims data and approved AI tools.

The position is designed for an early-career professional with healthcare claims experience.