Remote Quality Improvement Specialist (Healthcare Analytics)

Avalon Administrative Services LLC; Oregon; Hybrid; USD 65,000 - 90,000; Full time

Job summary

Avalon Healthcare Solutions is seeking a Quality Improvement Specialist to advance quality initiatives and performance measurement. You will work with Medical Policy, Coding, and Analytics to drive improvements in claims processing and policy alignment.

The role requires 3–5 years of healthcare quality experience, a bachelor’s degree (or equivalent), and relevant coding certifications. Remote work is allowed with quarterly travel to Tampa, FL for team collaboration and strategy sessions.

Qualifications

• 3-5 years of Health Care Quality Improvement experience in a managed care or health care services setting.
• Bachelor's degree or equivalent experience.
• Certification in Healthcare Billing/Coding (CPC/CCS/CPMA) or related credentials.

Responsibilities

• Manage and monitor quality auditing across claims data, develop improvement recommendations, implement plans, and evaluate results.
• Perform quality auditing based on data analytics with focus on consistency and accuracy of results.
• Deliver quarterly and monthly quality auditing findings and recommendations.
• Collaborate with Medical Policy, Configuration, Policy and Enforcement, Coding and Translation to reflect policies correctly.
• Monitor Quality Improvement metrics, coordinate cross-functional teams, and drive action to meet performance goals.

Skills

Health Care Quality Improvement

Healthcare analytics

Written and oral communication

Microsoft Excel

Independent worker

Education

Bachelor's degree or equivalent experience

CPC/CCS/CPMA Certification

Tools

SQL

PowerBI

JIRA

Job description

Avalon Healthcare Solutions is seeking a Quality Improvement Specialist to advance quality initiatives and performance measurement. You will work with Medical Policy, Coding, and Analytics to drive improvements in claims processing and policy alignment.

The role requires 3–5 years of healthcare quality experience, a bachelor’s degree (or equivalent), and relevant coding certifications. Remote work is allowed with quarterly travel to Tampa, FL for team collaboration and strategy sessions.