Note: The job is a remote job and is open to candidates in USA. Avalon Healthcare Solutions is hiring a Quality Improvement Research Analyst to support its Quality Department and client service delivery. The role resolves client inquiries and operational issues through claims research, reporting, and cross-functional collaboration.

Responsibilities

• Act as the Quality Subject Matter Expert and support team for service delivery
• Maintain in-depth knowledge of internal processes to effectively resolve customer inquiries
• Develop, run, and execute client queries for internal reports
• Pull and prepare monthly, quarterly, and ad hoc reports for assigned clients
• Evaluate disputed claims in denial management process for system configuration, claims processing, and/or contractual issues to facilitate health plan review of claims
• Support the resolution of operational inaccuracies and trends
• Collaborate with Service Delivery team and other internal departments to provide excellent service
• Understand departmental needs and recommend process improvements
• Support special assignments and projects that require extensive and thorough research

Skills

• Minimum years of relevant work experience: 3+ years' in a relevant healthcare field – claims processing, claims coding, customer service, and/or account management
• 5+ years relevant experience in lieu of a degree
• Previous experience working in a health plan or healthcare services company is required
• Maintains a solutions-oriented, analytical mindset, even when faced with ambiguity or shifting priorities
• Demonstrates a strong sense of ownership and accountability for outcomes and continuous improvement
• Expert proficiency in written and oral communication skills required with a high attention to detail to documentation
• Working knowledge of SQL queries to run client reports
• Expert proficiency in computer skills including Microsoft Office Suite products (Excel advanced a must)
• Attention to detail is critical
• Experience with data analysis tools
• Reporting and JIRA experience is preferred
• Experience or certification in medical billing and/or medical coding a plus
• Knowledge of and experience with laboratory medical coding rule and regulations, compliance, reimbursement, and bundling issues
• Bachelor's degree preferred

Benefits

• Eligible for remote work, with quarterly travel required to Avalon’s corporate office in Tampa, Florida.

Company Overview