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Consultant II, Market Access (Strategic Certified Professional Coder)

LOCATION: Remote
REMOTE ELIGIBLE: Fully Remote
REQUISITION ID: 460
<p>Avalere Health is a strategic advisory company whose core purpose is to create innovative solutions to complex healthcare problems. Based in Washington, DC, the firm delivers actionable insights, business intelligence tools, and custom analytics for leaders in healthcare business and policy. Avalere’s experts span 230 staff drawn from Fortune 500 healthcare companies, the federal government (e.g., CMS, OMB, CBO, and the Congress), top consultancies, and nonprofits. The firm offers deep substance on the full range of healthcare business issues affecting the Fortune 500 healthcare companies. As an Inovalon company (Nasdaq: INOV), Avalere’s focus on strategy is supported by outstanding data analytics that generate unique insights and meaningful business improvement. Through events, publications, and interactive programs, Avalere insights are accessible to a broad range of customers.</p> <p>Avalere Health is seeking a <strong>Strategic Certified Professional Coder</strong> (Consultant II) to join our Market Access &amp; Reimbursement Practice. The team focuses on a wide range of areas, such as: coverage, coding, and payment across commercial and public payers; pricing and contracting; distributors and specialty pharmacies; field team design and deployment; and patient support services. We assess how our clients’ products fit within the emerging coverage and reimbursement landscape and help our clients optimize market access for their products though deep subject matter expertise and understanding of their business issues.</p> <p>We design strategic and tactical plans to maximize adoption and uptake by payers, providers, and patients throughout the product lifecycle by integrating policy and healthcare market dynamics into the business planning cycle.&nbsp;We work on a team basis with complementary scientific, technical, and regulatory expertise in the pre-approval and post-market spaces.</p> <p><strong>Responsibilities:</strong></p> <ul> <li>Serves as a staff authority on healthcare coding, related payment policies and methodologies used for the fee schedule and makes recommendations on annual rule revisions to upper management&nbsp;</li> <li>Provides guidance on coding rule and regulation interpretation to stakeholders, provides review assistance to internal staff, keeps management and staff apprised of current trends</li> <li>Serves as a coding subject matter expert on reimbursement and market access-related issues impacting the pharmaceutical, biotech, and medical device industries</li> <li>Participates on project teams to solve complex client coding problems and engage clients with novel solutions and ideas</li> <li>Creates both strategic and tactical coding recommendations for clients to ensure optimal market access for client products</li> <li>Conceptualizes coding project scopes for clients, assembling a cross-functional team, and overseeing the team from project initiation through to client delivery</li> <li>Solves complex coding issues in a timely and appropriate manner with minimal management oversight and attention to resources.</li> <li>Maintain compliance with Inovalon’s policies, procedures and mission statement</li> <li>Adhere to all confidentiality and HIPAA requirements as outlined within Inovalon’s Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position</li> <li>Fulfill those responsibilities and/or duties that may be reasonably provided by Inovalon for the purpose of achieving operational and financial success of the Employer.</li> </ul> <p><strong>Skills, Experience, and Other Job-Related Requirements:</strong></p> <ul> <li>Bachelor’s degree in health policy, public policy, healthcare management, public health, public administration, health economics, business administration, law, or a relevant discipline</li> <li>Medical Coding Certificate; RHIT or CPC by AHIMA or AAPC license; meet state licensure requirements with more than 2 years of experience; Maintain coding certification and attend in-service training as required</li> <li>Comprehensive understanding the appropriate sequencing and assignment of ICD-10, CPT, HCPCS, as well as a thorough knowledge of DRG coding</li> <li>2 years of consulting experience is preferred</li> <li>2-3 years reimbursement-specific experience is preferred</li> <li>Understanding of medical terminology, anatomy, and physiology</li> <li>Ability to establish personal credibility as a strategic, coding expert with clients</li> <li>Project management experience that includes interacting with and presenting to senior-level executives and/or health policy leaders, preferred</li> <li>Exemplary interpersonal skills that translate into positive relationships with colleagues and clients</li> <li>Ability to work independently or as an active member of a team</li> <li>Strong proficiency in Microsoft Office Suite</li> <li>Accurate and precise attention to detail</li> <li>Ability to multitask, prioritize, and manage time efficiently</li> <li>Excellent verbal and written communication skills</li> </ul><div class="content-conclusion"><p><em>The Company maintains a drug free work environment for all of its associates, which includes employees, contractors and vendors. It is unlawful for associates to manufacture, sell, distribute, dispense, possess or use any controlled substance or marijuana in the workplace and doing so will result in disciplinary action, up to and including termination of employment or the contracted relationship. </em></p> <p><em>By embracing diversity, equity and inclusion we enhance our work environment and drive business success. Inovalon strives to reflect the diversity of the communities where we operate and of our clients and everyone whom we serve. We endeavor to create a culture of inclusion in which our associates feel empowered to bring their full, authentic selves to work and pursue their professional goals in an equitable setting. We understand that by fostering this type of culture, and welcoming different perspectives, we generate innovation and growth.</em></p></div>

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