Quality Support AnalystAvalon Administrative Services LLC

About Avalon Healthcare Solutions:

Avalon Healthcare Solutions is the nation’s leader in diagnostic intelligence, uniquely focused on transforming the role of diagnostic testing across the healthcare ecosystem. Our proprietary Diagnostic Insights Platform delivers evidence-based policies, curated lab networks, and real-time analytics that simplify complex diagnostics, accelerate innovation adoption, and optimize diagnostic investments.

Supporting over 30 health plans and 100 million members nationwide, Avalon partners with payers and providers to ensure diagnostic testing is performed appropriately, efficiently, and at the right time. Our flexible solutions span routine and genetic testing management, automated adherence, and end-to-end diagnostics support—driving measurable value, reduced waste, and improved clinical outcomes.

With unmatched scientific rigor, deep clinical expertise, and a performance-based model, Avalon is redefining how diagnostics power personalized care and healthcare value.
 You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve.

For more information about Avalon, please visit www.avalonhcs.com.

Avalon Healthcare Solutions is an Equal Opportunity Employer - Vet/Disability.  

This position description is subject to change at any time. As determined by the company based upon business needs, an employee in this position may be required to perform duties and take responsibility for work other than as described in this document.

About the Quality Reporting Analyst I:

The Quality Reporting Analyst I supports the Quality Department by ensuring the accuracy, integrity, and compliance of client-facing reporting and operational outputs. This role conducts claims research, analyzes operational data, and collaborates with internal teams to resolve client inquiries and operational issues. The analyst also serves as a quality subject matter expert, validating reports, applying reporting standards, and maintaining processes that support reliable service delivery. The position requires strong analytical skills, attention to detail, and the ability to manage multiple priorities in a data-driven environment.

This position is eligible for remote work, but quarterly travel will be required to Avalon's corporate office located in Tampa, Florida.

Quality Reporting Analyst I – Essential Functions and Responsibilities:

Serve as a subject matter expert for quality standards and reporting integrity, ensuring client-facing deliverables meet established guidelines and compliance requirements.Perform quality assurance reviews to validate accuracy, completeness, and appropriate data inclusion in reports and deliverables.Ensure adherence to reporting standards, including proper use of data filters, correct date ranges, and exclusion of restricted or inappropriate data elements.Run and analyze Universe at Risk (UAR) reports.Evaluate findings using established thresholds to determine client-reportable issues versus internal maintenance updates.Assess findings and determine appropriate classification of issues (Level I, Level II, or Level III) based on established reporting thresholds.Escalate Level III issues to the appropriate team or role for further review and resolution.Prepare and validate Impact Reports and maintain documentation related to plan changes and reporting outcomes.Support service reliability processes by managing issue tracking, maintaining reporting workflows, and coordinating peer reviews.Track and manage tickets, determine issue classification levels, estimate resolution timelines, and communicate delivery schedules with Client Service Delivery.Upload finalized reports and documentation to internal systems (e.g., JIRA) for distribution and tracking.Develop and execute client-specific queries using SQL and Excel to generate internal, monthly, quarterly, and ad hoc reports.Conduct claims research and evaluate disputed claims to identify system configuration, processing, or contractual issues.Identify operational inaccuracies or trends and support issue resolution through cross-functional collaboration.Recommend process improvements to enhance reporting accuracy, quality oversight, and operational efficiency.Support special projects and research assignments as needed.

Quality Reporting Analyst I– Minimum Qualifications:

• Previous experience working in a health plan or healthcare services company is required.
• Bachelor’s degree preferred; 5+ years relevant experience in lieu of a degree 
• 3+ years’ in a relevant healthcare field – claims processing, claims coding, customer service, and/or account management
• Maintains a solution-oriented, analytical mindset, even when faced with ambiguity or shifting priorities.
• Demonstrates a strong sense of ownership and accountability for outcomes and continuous improvement.
• Open communication and consistent follow up to keep deliverables on track.
• Expert proficiency in written and oral communication skills required with a high attention to detail to documentation. 
• Working knowledge of SQL queries for developing and executing queries.
• Expert proficiency in computer skills including Microsoft Office Suite products (Excel advanced a must).
Strong organizational skills and attention to detail.

Quality Reporting Analyst I– Preferred Qualifications:

Experience with data analysis or reporting tools (e.g., Tableau).Experience with JIRA or similar ticketing/workflow management systems.Experience or certification in medical billing or medical coding.Knowledge of laboratory medical coding rules, compliance requirements, reimbursement methodologies, and bundling practices.