Quality Improvement Research Analyst

About Avalon Healthcare Solutions:

Avalon Healthcare Solutions is the nations leader in diagnostic intelligence uniquely focused on transforming the role of diagnostic testing across the healthcare ecosystem. Our proprietary Diagnostic Insights Platform delivers evidence-based policies curated lab networks and real-time analytics that simplify complex diagnostics accelerate innovation adoption and optimize diagnostic investments.

Supporting over 30 health plans and 100 million members nationwide Avalon partners with payers and providers to ensure diagnostic testing is performed appropriately efficiently and at the right time. Our flexible solutions span routine and genetic testing management automated adherence and end-to-end diagnostics supportdriving measurable value reduced waste and improved clinical outcomes.

With unmatched scientific rigor deep clinical expertise and a performance-based model Avalon is redefining how diagnostics power personalized care and healthcare value. 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 .

Avalon Healthcare Solutions is an Equal Opportunity Employer - Vet/Disability.

This position description is subject to change at any time. As determined by the company based upon business needs an employee in this position may be required to perform duties and take responsibility for work other than as described in this document.

About the Quality Improvement Research Analyst Position:

The QI Research Analyst is a key member of the Quality Department supporting the internal operations needed for stellar client service delivery. This position is responsible for resolution of client inquiries and issues including triaging requests and conducting detailed claims research. The QI Research Analyst works cross-functionally with other departments to conduct research pull claims data and obtain information as needed from other departments to understand and resolve operational issues.

This position is eligible for remote work but quarterly travel will be required to Avalons corporate office located in Tampa Florida.

Quality Improvement Research Analyst Essential Functions and 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.

Quality Improvement Research Analyst Minimum Qualifications:

• Minimum years of relevant work experience: 3 years in a relevant healthcare field claims processing claims coding customer service and/or account management
• Minimum education: Bachelors degree preferred; 5 years relevant experience in lieu of a degree
• Required certification: n/a
• 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.
• communication and consistent follow up to keep deliverables on track.
• 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.

Quality Improvement Research Analyst Preferred Qualifications:

• 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.

Required Experience:

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