Consultant I, Strategic Certified Professional Coder

Avalere Health is seeking a Strategic Certified Professional Coder to join our Market Access & Reimbursement Practice.

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.

Avalere Health is seeking a Strategic Certified Professional Coder to join our Market Access & Reimbursement Practice. We are looking for a motivated professional to serve as a staff authority on healthcare coding and related payment policies.

  • 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
  • Provides guidance on coding rule and regulation interpretation to stakeholders, provides review assistance to internal staff, keeps management and staff apprised of current trends
  • Serves as a coding subject matter expert on reimbursement and market access-related issues impacting the pharmaceutical, biotech, and medical device industries
  • Participates on project teams to solve complex client coding problems and engage clients with novel solutions and ideas
  • Creates both strategic and tactical coding recommendations for clients to ensure optimal market access for client products
  • Conceptualizes coding project scopes for clients, assembling a cross-functional team, and overseeing the team from project initiation through to client delivery
  • Solves 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 related field
  • 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, HCPCS, as well as a thorough knowledge of DRG coding
  • Understanding of medical terminology, anatomy, and physiology
  • Ability to establish personal credibility as a strategic, coding expert with clients
  • Project management experience that includes interacting with and presenting to senior-level executives and/or health policy leaders, preferred
  • 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 computer skills 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
*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.