[Hiring] QI Research Analyst @Avalon Administrative Services LLC

Role Description

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 Avalon’s corporate office located in Tampa, Florida.

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.

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: Bachelor’s degree preferred; 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.

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 rules and regulations, compliance, reimbursement, and bundling issues.