QI Research Analyst

Avalon Administrative Services LLC • Tampa, FL

4d • Remote

About The Position

The QI Research Analyst is a key member of Avalon Healthcare Solutions’ Quality Department, supporting internal operations and client service delivery. The role resolves client inquiries and issues by triaging requests, conducting detailed claims research, and working cross-functionally to gather claims data and information needed to understand and address operational issues. The position is eligible for remote work, with quarterly travel to Avalon’s corporate office in Tampa, Florida.

Requirements

• At least 3 years of relevant work experience in a healthcare field, such as claims processing, claims coding, customer service, or account management.
• Previous experience working for a health plan or healthcare services company.
• A solutions-oriented, analytical mindset, including the ability to work through ambiguity and shifting priorities.
• Strong ownership and accountability for outcomes and continuous improvement.
• Communication and consistent follow-up to keep deliverables on track.
• Expert written and oral communication skills, with close attention to documentation detail.
• Working knowledge of SQL queries for running client reports.
• Expert computer skills, including Microsoft Office; advanced Excel proficiency is required.
• Strong attention to detail.

Nice To Haves

• Bachelor’s degree preferred; five or more years of relevant experience may substitute for a degree.
• Experience with data analysis tools.
• Reporting and JIRA experience.
• Experience or certification in medical billing and/or medical coding.
• Knowledge of laboratory medical coding rules and regulations, compliance, reimbursement, and bundling issues.

Responsibilities

• 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.
• Prepare monthly, quarterly, and ad hoc reports for assigned clients.
• Evaluate disputed claims in the denial management process for system configuration, claims processing, and contractual issues to facilitate health plan review.
• Support the resolution of operational inaccuracies and trends.
• Collaborate with the Service Delivery team and other internal departments to provide excellent service.
• Understand departmental needs and recommend process improvements.
• Support special assignments and projects requiring extensive research.

What This Job Offers

• Job Type: Full-time