Policy and Publication Specialist

About Avalon Healthcare Solutions:

Avalon Healthcare Solutions is the nation’s leader in diagnostic intelligence, uniquely focused on transforming the role of diagnostic testing across the healthcare ecosystem. Our proprietary Diagnostic Insights Platform delivers evidence-based policies, curated lab networks, and real-time analytics that simplify complex diagnostics, accelerate innovation adoption, and optimize diagnostic investments. Supporting over 30 health plans and 100 million members nationwide, Avalon partners with payers and providers to ensure diagnostic testing is performed appropriately, efficiently, and at the right time. Our flexible solutions span routine and genetic testing management, automated adherence, and end-to-end diagnostics support—driving measurable value, reduced waste, and improved clinical outcomes. With unmatched scientific rigor, deep clinical expertise, and a performance-based model, Avalon is redefining how diagnostics power personalized care and healthcare value. You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve.

For more information about Avalon, please visit https://www.avalonhcs.com.

Avalon Healthcare Solutions is an Equal Opportunity Employer - Vet/Disability.

This position description is subject to change at any time. As determined by the company based upon business needs, an employee in this position may be required to perform duties and take responsibility for work other than as described in this document.

About the Policy and Publication Specialist:

The Policy and Publication Specialist team member is part of the Policy Operations and Enforcement Team reporting directly to the Policy and Publication Manager. The Policy and Publication Specialist is responsible for managing the distribution and publication of medical policies, including formatting, editing, and ensuring accuracy and clarity of information by collaborating with internal stakeholders to align Policy Operations and Enforcement updates with client medical policy requirements. 

Policy and Publication Specialist – Essential Functions and Responsibilities:

• Collaborate with internal stakeholders supporting quarterly medical policy maintenance activities.
• Edit and proofread revised client medical policies to ensure accuracy and consistency of prior/current client policy language/decisions.
• Communicate medical policy updates clearly to clients and 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 configurational requirements.
• Collaborate with other departments to proactively seek client medical policy decisions. 
• Collaborate with the Implementation Team by facilitating medical policy reconciliation meetings with new clients. Traveling to client location required.
• Remote workers are required to travel to Avalon’s Tampa office for quarterly in-person meetings when scheduled. 
• Engagement in the creation and transition of the IT ticketing system to support transitioning workflow. 
• Maintain and update data resources to ensure accurate and reliable reporting.

Policy and Publication Specialist – Minimum Qualifications:

• 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, with a preference for intermediate knowledge of SQL 
• Knowledge of one or more of the following areas of health plan operations - configuration, utilization, claims processing, and/or reimbursement.
• Proven analytical and project management skills, including a thorough understanding of how to interpret customer business needs and translate them into application and operational requirements.
• Facilitation skills that include workgroup leadership, problem resolution across multiple groups, etc.
• Willingness to work in various capacities and to learn new skill sets.

Policy and Publication Specialist – Preferred Qualifications:

• Experience creating/revising policies, standard operating procedures and/or guidelines within a managed care organization or similar health care environment.
• Understand and experience working with CPT codes and diagnosis codes.
• Understand process improvement principles.
• Outstanding written and verbal communication skills. 
• Proficient computer skills (Excel, Word, Power Point, Jira, PDF creation).
• Strong organization skills and ability to prioritize and manage multiple projects.
• Flexible and ability to learn new technologies.
• Ability to interact effectively with counterparts and assigned clients.
• Ability to interpret and synthesize complex healthcare literature and clinical information.

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