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Policy and Publication Specialist
Avalon Healthcare Solutions. Manage the distribution and publication of medical policies .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing medical policy distribution and publication, ensuring accuracy and clarity in documentation. Proficient in collaborating with cross-functional teams and stakeholders to align business requirements with healthcare operations.
Highest-signal resume keywords
Medical Policy ManagementProject Management SkillsUse Case TestingHealth Plan Operations KnowledgeAnalytical 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
Microsoft ExcelMicrosoft AccessSQLCPT CodesDiagnosis CodesPolicy CreationReportingProcess ImprovementData Resource ManagementWorkflow Transition
Soft Skills
Outstanding Written CommunicationOutstanding Verbal CommunicationOrganizational SkillsFacilitation SkillsProblem Resolution
Tools & Technologies
JiraPowerPointPDF Creation
Industry Keywords
Healthcare BusinessManaged Care OrganizationClient InteractionMedical Policy InterpretationCross-Functional Collaboration
Tech Stack
Tools & technologiesSQL
About the role
Key responsibilities & impact- Manage the distribution and publication of medical policies
- Format, edit, and ensure the accuracy and clarity of medical policy information
- Collaborate with internal stakeholders on quarterly medical policy maintenance activities
- Edit and proofread revised client medical policies for accuracy and consistency of prior and current policy language and decisions
- Communicate medical policy updates clearly to clients
- 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 configuration requirements
- Proactively seek client medical policy decisions with other departments
- Facilitate medical policy reconciliation meetings with new clients in collaboration with the Implementation Team
- Travel to client locations as required
- Travel to Avalon’s Tampa office for quarterly in-person meetings when scheduled for remote workers
- Engage in creation and transition of the IT ticketing system to support workflow transition
- Maintain and update data resources for accurate and reliable reporting
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
- Preference for intermediate knowledge of SQL
- 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
- 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 organizational 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 preferred
Benefits
Comp & perks- Equal Opportunity Employer - Vet/Disability
- Remote work arrangement indicated, with quarterly in-person meetings at Avalon’s Tampa office when scheduled
- Opportunity to help shape a new market and business
- Opportunity to improve clinical outcomes and health care affordability
- Team collaboration with internal stakeholders and cross-functional teams