Clinical Validation Analyst at Avalon Administrative Services, LLC dba Avalon Healthcare Solutions in Tampa, Florida

Job Description:

Avalon Healthcare Solutions, headquartered in Tampa, Florida, is the world's first and only Lab Insights company, bringing together our proven Lab Benefit Management solutions, lab science expertise, digitized lab values, and proprietary analytics to help healthcare insurers proactively inform appropriate care, reduce costs, and improve clinical outcomes. Working with health plans across the country, the company covers more than 36 million lives and delivers 7-12% outpatient lab benefit savings. Avalon is pioneering a new era of value-driven care with its Lab Insights Platform that captures, digitizes, and analyzes lab results in real time to provide actionable insights for earlier disease detection, ensuring appropriate treatment protocols, and driving down overall cost.

Studies show that 30% of clinical laboratory testing is unnecessary or overused. Inappropriate testing or missing a key screening can lead to complications and expense arising from unwarranted care, or not obtaining proper care when needed, leading to increased health risks and costs. Avalon helps ensure delivery of the right test, at the right time, and in the right setting. We seek to ensure the most effective patient treatment, improve clinical outcomes, and optimize cost and affordability.

Avalon is a portfolio company of Francisco Partners, a global private equity firm that specializes in investments in technology and technology-enabled service companies.

Avalon is a high growth company where every associate has an opportunity to make a difference. 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 www.avalonhcs.com.

Avalon Healthcare Solutions is proud to be an equal opportunity employer including disability/veteran. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.

Avalon Healthcare Solutions provides and maintains a drug-free workplace for its employees.

For more about Avalon, please visit our web site at http://www.avalonhcs.com.

About the Clinical Validation Analyst:

The Clinical Validation Analyst will be responsible for ensuring the accuracy and integrity of process outputs before deployment to production processes. This role requires a strong understanding of clinical conditions, ICD-10 and HCPCS coding, and experience with API testing tools and claim editing systems. This role collaborates closely with cross-functional teams to ensure the delivery of quality solutions. As part of the Policy Operations and Enforcement team, the Clinical Validation Analyst reports to the Senior Manager, Configuration.

This position is eligible for remote work, but quarterly travel to the corporate office in Tampa, Florida is required.

Clinical Validation Analyst – Essential Functions and Responsibilities:

• Validate output from operational processes to ensure accuracy before deploying instructions to established software programs.
• Utilize API testing tools to verify integrations and ensure the functionality of claim editing systems.
• Review and analyze ICD-10 and HCPCS coding for compliance with medical and billing standards.
• Collaborate with cross-functional teams to ensure outputs align with clinical conditions and industry regulations.
• Develop and maintain validation protocols and test cases for various healthcare applications.
• Identify and resolve discrepancies in data processing and claims adjudication systems.
• Apply systems thinking to evaluate and improve validation workflows and procedures.

Clinical Validation Analyst – Minimum Qualifications:

• 5+ years of experience in healthcare operations, medical coding, or claims adjudication, with a focus on quality assurance or validation processes.
• Bachelor's degree or 10+ years' direct, applicable experience in lieu of a degree.
• RN/LPN strongly preferred
• Strong familiarity with clinical conditions and healthcare coding systems (ICD-10, HCPCS).
• Experience with API testing tools and claim editing systems.
• Logical, analytical mindset with a keen eye for detail and accuracy.
• Curiosity and proactive problem-solving skills, with the ability to analyze complex systems.
• The ideal candidate is analytical, detail-oriented, and exhibits systems thinking to troubleshoot and improve validation workflows.

Clinical Validation Analyst – Qualifications Preferred:

• Master's degree in Health Informatics, Information Systems, Healthcare Administration, or a related field.
• Advanced certifications such as Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Professional Medical Auditor (CPMA).
• Experience with advanced API testing tools (e.g., Postman, SoapUI, ReadyAPI) and validation in healthcare software systems.
• Demonstrated expertise in clinical claims editing systems
• Strong knowledge of regulatory requirements and compliance standards in healthcare, including HIPAA, CMS guidelines, and payer-specific rules.
• Proven track record of process improvement and automation in validation or quality assurance roles.

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