Note: The job is a remote job and is open to candidates in USA. Avalon Healthcare Solutions is hiring a QI Research Analyst to support Quality Department operations and client service delivery. The role resolves client inquiries through claims research, reporting, and cross-functional investigation of operational issues.
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
- Bachelor's degree preferred
- 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
Benefits
- Eligible for remote work, with quarterly travel required to Avalon’s corporate office in Tampa, Florida.
Company Overview