Quality Improvement Research Analyst

Job not on LinkedIn

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔬 Research Analyst

👻 Ghost score 11%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Avalon Healthcare Solutions

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2013

🏥 Healthcare

☁️ SaaS

⚕️ Healthcare Insurance

Healthcare • SaaS • Healthcare Insurance

Avalon Healthcare Solutions is a healthcare technology company that provides a Diagnostic Intelligence platform and benefit-management services to health plans, labs, and providers. Using evidence-based policies, real-time test decisioning, curated lab networks, automated workflows, and analytics, Avalon manages and optimizes diagnostic testing — including genetic testing, oncology (liquid biopsy), cardiometabolic, and routine labs — to reduce waste, speed care, and improve outcomes. The company focuses on lab benefit management, precision genetic test management, and analytics to deliver measurable savings and operational oversight for payers and diagnostic partners.

📋 Description

• Act as the Quality Subject Matter Expert and support team for service delivery • Maintain in-depth knowledge of internal processes to 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 the denial management process for system configuration, claims processing, and/or contractual issues • Facilitate health plan review of claims • Support resolution of operational inaccuracies and trends • Collaborate with the Service Delivery team and other internal departments • Understand departmental needs and recommend process improvements • Support special assignments and projects requiring extensive research • Resolve client inquiries and issues by triaging requests and conducting detailed claims research • Pull claims data and obtain information from other departments to understand and resolve operational issues

🎯 Requirements

• Minimum 3+ years of relevant work experience in a healthcare field, including claims processing, claims coding, customer service, and/or account management • Bachelor’s degree preferred; 5+ years of relevant experience accepted in lieu of a degree • Previous experience working in a health plan or healthcare services company required • Solutions-oriented, analytical mindset • Strong ownership and accountability for outcomes and continuous improvement • Strong communication and consistent follow-up to keep deliverables on track • Expert written and oral communication skills • High attention to detail in documentation • Working knowledge of SQL queries • Expert computer skills, including Microsoft Office Suite; advanced Excel required • Experience with data analysis tools preferred • Reporting and JIRA experience preferred • Experience or certification in medical billing and/or medical coding a plus • Knowledge of laboratory medical coding rules and regulations, compliance, reimbursement, and bundling issues

🏖️ Benefits

• Eligible for remote work • Quarterly travel to Avalon’s corporate office in Tampa, Florida