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Policy and Publication Specialist
Avalon Healthcare Solutions. Collaborate with internal stakeholders on quarterly medical policy maintenance activities .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical policy management, including editing, proofreading, and communicating updates effectively. Proficient in project management and analytical skills, with a strong understanding of healthcare operations and reporting.
Highest-signal resume keywords
Medical Policy ManagementProject ManagementAnalytical SkillsHealthcare Operations KnowledgeCommunication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Business Requirements DevelopmentUse Case TestingReportingSQLCPT Code UnderstandingDiagnosis Code UnderstandingProcess Improvement PrinciplesMicrosoft ExcelMicrosoft AccessData Resource Maintenance
Soft Skills
Facilitation SkillsWorkgroup LeadershipProblem ResolutionOrganization SkillsFlexibility
Tools & Technologies
Microsoft WordMicrosoft PowerPointJiraPDF Creation
Industry Keywords
Healthcare BusinessManaged Care OrganizationClient Medical PolicyClaims ProcessingUtilizationReimbursementPolicy RevisionsStandard Operating Procedures
Tech Stack
Tools & technologiesSQL
About the role
Key responsibilities & impact- Collaborate with internal stakeholders on quarterly medical policy maintenance activities
- Edit and proofread revised client medical policies for accuracy and consistency
- Communicate medical policy updates to clients and respond to policy interpretation and implementation inquiries
- Manage publication processes, including uploading content to online platforms
- Collaborate with cross-functional teams on coding, translation, and configuration requirements
- Work with other departments to obtain client medical policy decisions
- Facilitate medical policy reconciliation meetings with new clients alongside the Implementation Team
- Travel to client locations
- Attend quarterly in-person meetings at Avalon’s Tampa office when scheduled
- Participate in creating and transitioning the IT ticketing system to support workflow transitions
- Maintain and update data resources for accurate and reliable reporting
- Report directly to the Policy and Publication Manager
Requirements
What you’ll need- At least 3 years of experience developing and managing business requirements throughout a project lifecycle
- Experience in or knowledge of the health care business and customer service
- Intermediate knowledge of Microsoft Excel and Access
- Experience with use case testing
- 1–2 years’ experience in reporting
- Knowledge of one or more health plan operations areas: configuration, utilization, claims processing, and/or reimbursement
- Proven analytical and project management skills
- Thorough understanding of interpreting customer business needs and translating them into application and operational requirements
- Facilitation skills, including workgroup leadership and problem resolution across multiple groups
- Willingness to work in various capacities and learn new skill sets
- Preferred: intermediate knowledge of SQL
- Preferred: experience creating/revising policies, standard operating procedures, and/or guidelines within a managed care organization or similar health care environment
- Preferred: understanding and experience working with CPT codes and diagnosis codes
- Preferred: understanding of process improvement principles
- Preferred: outstanding written and verbal communication skills
- Preferred: proficient computer skills in Excel, Word, PowerPoint, Jira, and PDF creation
- Preferred: strong organization skills and ability to prioritize and manage multiple projects
- Preferred: flexibility and ability to learn new technologies
- Preferred: ability to interact effectively with counterparts and assigned clients
- Preferred: ability to interpret and synthesize complex healthcare literature and clinical information
Benefits
Comp & perks- Equal Opportunity Employer - Vet/Disability
- Remote work arrangement
- Quarterly in-person meetings at Avalon’s Tampa office for remote workers
- Travel to client locations