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

Job Description:

Title: Clinical Validation Analyst

Category: Full Time

Position Type: 2D

Requsition ID: 1003

Description:

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.

PM18

Equal employment opportunity, including veterans and individuals with disabilities.

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