Supervisor, Quality Improvement

Avalon Administrative Services LLC•Tampa, FL

9d•Remote

About The Position

The Supervisor, Quality Improvement is responsible for overseeing Avalon’s quality improvement auditing and monitoring activities while leading a team of Quality Improvement Specialists. This position serves as a working leader, directly participating in quality audits, data analysis, reporting, and process improvement initiatives while ensuring the team consistently delivers accurate, timely, and actionable quality insights. The Supervisor collaborates across Clinical Operations, Medical Policy, Configuration, Coding, Translation, Client Delivery, and other operational teams to support Avalon’s Quality Improvement Program, identify opportunities for improvement, and drive performance against organizational goals, client requirements, and regulatory standards. This position is eligible for remote work, but quarterly travel will be required to Avalon’s corporate office located in Tampa, Florida.

Requirements

5+ years of healthcare quality improvement, auditing, claims analysis, or related healthcare operations experience
2–3 years of supervisory, team lead, or people leadership experience
Bachelor's degree in Healthcare Administration, Business, Nursing, Health Information Management, or a related field or equivalent combination of education and relevant experience
Strong knowledge of healthcare claims processing, medical billing, reimbursement methodologies, and medical coding
Working knowledge of ICD-10, CPT, and HCPCS coding principles
Experience conducting quality audits and translating findings into process improvements
Strong analytical and problem-solving skills with high attention to detail
Advanced Microsoft Excel skills and proficiency with Microsoft Office applications
Strong written, verbal, and presentation skills
Ability to prioritize multiple projects and deadlines in a fast-paced environment
Demonstrated leadership, coaching, and employee development capabilities
Ability to build effective working relationships across departments

Nice To Haves

CPC (Certified Professional Coder), CCS (Certified Coding Specialist), and/or CPMA (Certified Professional Medical Auditor) certifications preferred
Experience in a managed care, payer, or healthcare services organization
Experience supporting Quality Improvement or NCQA-related programs
Laboratory, genetic testing, or diagnostic management experience
Experience with Power BI, SQL, JIRA, or similar reporting and analytics tools
Certification in Healthcare Quality (CPHQ) preferred
Clinical, coding, compliance, or health information management background

Responsibilities

Supervise, coach, develop, and evaluate a team of Quality Improvement Specialists
Establish team goals, performance expectations, and productivity standards
Monitor workload distribution and ensure timely completion of quality audits, reporting, and improvement initiatives including ad hoc requests and shifting of priorities as new tasks arise.
Provide ongoing training, mentoring, and professional development opportunities
Support hiring, onboarding, performance management, and succession planning activities
Foster a culture of accountability, continuous improvement, collaboration, and customer service
Perform and oversee quality auditing activities, including review and analysis of claims data, identification of trends, development of recommendations, and monitoring of corrective actions
Review audit findings and reports for accuracy, consistency, and completeness
Monitor quality performance metrics and identify opportunities for process improvement
Conduct root cause analyses and facilitate corrective action planning with operational stakeholders
Support development, implementation, and evaluation of quality improvement initiatives
Ensure quality activities are aligned with organizational priorities, client expectations, and regulatory requirements
Complete and oversee monthly, quarterly, and annual quality reporting activities
Assist in the development, maintenance, and evaluation of the annual Quality Improvement Work Plan
Monitor QI Work Plan metrics and performance trends, escalating concerns and recommending solutions as appropriate
Support delegation oversight activities, internal audits, and operational policy reviews
Collaborate with cross-functional teams to ensure accurate implementation of medical and claims payment policies
Analyze claims, operational, and quality performance data to identify trends, risks, and opportunities
Develop and present quality performance reports, audit findings, and recommendations to leadership
Ensure accuracy and integrity of quality data, reporting methodologies, and audit documentation
Partner with operational leaders to measure effectiveness of improvement initiatives and validate outcomes