Quality Improvement Specialist

About Avalon Healthcare Solutions

Avalon is the world’s first and only Lab Insights company, covering over 44+ million lives and delivering 10–20% savings in outpatient lab benefit costs. Backed by Francisco Partners, Avalon is pioneering real-time lab value digitization to improve outcomes, reduce costs, and inform value-driven healthcare decisions. Our mission: empower health plans to accelerate value-based care success.

Position Summary

The Quality Improvement Specialist drives quality improvement initiatives across the organization through auditing, data analysis, policy collaboration, and reporting. You’ll collaborate across teams and lead the execution and evaluation of a company-wide QI Work Plan, while ensuring compliance, accuracy, and continual improvement in health care delivery standards.

This is a remote position with quarterly travel to our Tampa, FL headquarters.

Key Responsibilities

• Perform quality audits on claims data; identify inconsistencies and trends

• Collaborate with Medical Policy, Configuration, and Coding teams to ensure claims and medical policy alignment

• Develop and implement recommendations for improvement based on audit findings

• Monitor QI metrics and trends; lead root cause analysis when metrics deviate from targets

• Develop and maintain annual QI Work Plan and conduct annual evaluations

• Prepare agendas and reports for the Quality Improvement Committee

• Support delegation oversight, internal audits, and policy reviews

• Collaborate with client health plans and internal stakeholders

• Maintain high levels of documentation and reporting accuracy

Required Qualifications

• Bachelor’s degree or equivalent experience

• 3–5 years of healthcare quality improvement experience, preferably in a managed care or vendor relationship setting

• Certified in CPC, CCS, and/or CPMA

• Working knowledge of medical policies, claims, and coding

• Advanced skills in Excel and Microsoft Office Suite

• Deep understanding of ICD-10, CPT, HCPCS coding principles

• Strong communication, analytical, and documentation skills

• Ability to work both independently and in cross-functional teams

Preferred Qualifications

• Experience with CMS billing/reimbursement methodologies

• Familiarity with lab/genetic test billing and commercial payer medical policies

• Proficient with data tools (e.g., SQL, PowerBI, JIRA)

• Certification in Healthcare Quality (CPHQ or similar)

• Background in biology, chemistry, medicine, or nursing

Why Join Avalon?

• Be part of a company creating a new healthcare category

• Work remotely with quarterly corporate gatherings

• Collaborate with some of the most innovative professionals in lab benefit management

• Impact the Triple Aim: better care, healthier populations, lower costs

Equal Opportunity Employer

Avalon Healthcare Solutions is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Remote with Quarterly Travel |  Full-Time |  Competitive Salary + Benefits