Healthcare Quality & Compliance Analyst

PREVEA HEALTH

Green Bay (WI)

On-site

USD 65,000 - 85,000

Full time

6 days ago

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Job summary

Prevea Health in Green Bay, WI is hiring a Quality Analyst/Auditor to manage quality measures across insurance contracts. You will review medical records, extract data, and ensure documentation aligns with contract requirements to optimize reimbursements.

Collaborating with clinicians and leadership, you will develop educational materials, support contract reviews, and push for workflow improvements. Prioritizing accuracy and compliance, you will help meet monthly and annual quality goals.

Qualifications

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.

Responsibilities

Review medical records and extract data to meet quality and audit metrics; verify accuracy of documentation and coding.
Assist with implementation of new contracts and programs, ensuring workflows meet contract requirements related to quality metrics.
Develop educational materials and guidance to providers and staff on quality metrics and contract requirements.
Support contract reviews by analyzing quality-related terms and interpreting performance thresholds to meet goals.
Prepare audit reports and streamline workflows to meet monthly, quarterly, and annual quality goals.
Monitor contract performance to identify gaps and recommend corrective actions.