Quality Analyst/Auditor- Hansen- Full Time
About The Position
The Quality Analyst/Auditor manages quality-related aspects of insurance contracts to help ensure Prevea Health receives negotiated reimbursements for meeting required quality metrics. The role reviews medical records, analyzes payer data, and collaborates with providers and leadership to support accurate documentation, compliance, and quality performance tied to insurance contracts. The position also supports new contract and program implementation, develops educational materials, analyzes quality-related contract terms, prepares audit reports, monitors performance, and identifies opportunities to improve workflows and automate quality data extraction.
Requirements
- At least 2 years of healthcare-related work experience.
- Familiarity with quality measures such as HEDIS.
- Understanding of medical record documentation and coding guidelines.
- Knowledge of medical insurance claims processes.
- Familiarity with insurance contracts.
- Strong analytical, auditing, and organizational skills.
- Ability to communicate effectively with providers, leadership, and cross-functional teams.
Nice To Haves
- Associate's degree in Healthcare Administration or a technical diploma in a healthcare-related field.
- Clinical experience as a medical assistant or LPN.
- Experience with electronic medical records, EPIC, and Microsoft Office.
Responsibilities
- Review medical records, extract data for quality and audit metrics, and verify documentation and coding accuracy.
- Review reports and data provided by insurance payors and perform audits and medical record validation.
- Assist with implementing new contracts and programs, ensuring workflows and processes meet quality-related contract requirements.
- Develop educational materials and guide providers and staff on quality metrics, documentation standards, and contract requirements.
- Analyze quality-related terms in assigned insurance contracts and amendments; interpret and communicate measure requirements and performance thresholds.
- Prepare audit reports and streamline workflows to meet monthly, quarterly, and annual quality and performance goals.
- Monitor assigned contract performance, identify gaps in quality requirements, and recommend and support corrective actions.
- Identify and support opportunities to automate quality data extraction using EPIC or other data sources.
- Collaborate with the Clinical Optimization Team, Chief Quality Officer, Chief Financial Officer, and physicians and clinicians to develop and implement best practices for quality-related workflows.
Benefits
- Continuous education, training, and support.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
