Certified Professional Coder, Consultant

Avalere Health is seeking a Certified Professional Coder/Consultant to join our Market Access & 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. 

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. We work on a team basis with complementary scientific, technical, and regulatory expertise in the pre-approval and post-market spaces. 

Responsibilities

  • Serve as a staff authority on healthcare coding and related payment policies and methodologies used for the fee schedule, and make recommendations on annual rule revisions to upper management     
  • Provide guidance on coding rule and regulation interpretation to stakeholders, provide review assistance to internal staff, and keep management and staff apprised of current trends   
  • Serve as a coding subject matter expert on reimbursement and market access-related issues impacting the pharmaceutical, biotech, and medical device industries   
  • Participate on project teams to solve complex client coding problems and engage clients with novel solutions and ideas  
  • Create both strategic and tactical coding recommendations for clients to ensure optimal market access for client products  
  • Conceptualize coding project scopes for clients, assembling a cross-functional team, and overseeing the team from project initiation through to client delivery   
  • Solve complex coding issues in a timely and appropriate manner with minimal management oversight and attention to resources

Skills, Experience, and Other Job-Related Requirements

Education Requirements

  • Bachelor’s degree in health policy, public policy, healthcare management, public health, public administration, health economics, business administration, law, or a relevant discipline   
  • 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   

Skill Requirements

  • Comprehensive understanding the appropriate sequencing and assignment of ICD-10, CPT, and HCPCS, as well as a thorough knowledge of DRG coding
  • Understanding medical terminology, anatomy, and physiology   
  • Ability to establish personal credibility as a strategic coding expert with clients   
  • Exemplary interpersonal skills that translate into positive relationships with colleagues and clients  
  • Ability to work independently or as an active member of a team   
  • Strong proficiency in Microsoft Office Suite   
  • Accurate and precise attention to detail   
  • Ability to multitask, prioritize, and manage time efficiently   
  • Excellent verbal and written communication skills 

Experience Requirements

  • 2 years of consulting experience is preferred   
  • 2–3 years reimbursement-specific experience is preferred   
  • Project management experience that includes interacting with and presenting to senior-level executives or health policy leaders preferred

Avalere is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.

Consistent with our safety protocols, the company will require a vaccination attestation for fully office-based and hybrid (office/remote) positions. Positions designated as fully remote are exempt from the attestation requirement unless and until such time as an in-office presence is required.