Supervisor, Quality Improvement - Healthcare Claims & Payment

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 https://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 Supervisor, Quality Improvement position:

This role focuses on healthcare claims auditing, reimbursement methodologies, payment accuracy, coding quality, data analysis, and quality improvement initiatives. Successful candidates typically possess experience in healthcare claims operations, quality auditing, medical billing, reimbursement review, coding validation, and process improvement, along with working knowledge of ICD-10, CPT, and HCPCS coding principles. Prior supervisory or team leadership experience is required. Experience with SQL, Power BI, JIRA, or similar reporting and analytics tools is preferred. 

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.

Supervisor, Quality Improvement – Essential Functions and Responsibilities:

Supervise, coach, develop, and evaluate a team of Quality Improvement SpecialistsEstablish team goals, performance expectations, and productivity standardsMonitor 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 opportunitiesSupport hiring, onboarding, performance management, and succession planning activitiesFoster a culture of accountability, continuous improvement, collaboration, and customer servicePerform and oversee quality auditing activities, including review and analysis of claims data, identification of trends, development of recommendations, and monitoring of corrective actionsReview audit findings and reports for accuracy, consistency, and completenessMonitor quality performance metrics and identify opportunities for process improvementConduct root cause analyses and facilitate corrective action planning with operational stakeholdersSupport development, implementation, and evaluation of quality improvement initiativesEnsure quality activities are aligned with organizational priorities, client expectations, and regulatory requirementsComplete and oversee monthly, quarterly, and annual quality reporting activitiesAssist in the development, maintenance, and evaluation of the annual Quality Improvement Work PlanMonitor QI Work Plan metrics and performance trends, escalating concerns and recommending solutions as appropriateSupport delegation oversight activities, internal audits, and operational policy reviewsCollaborate with cross-functional teams to ensure accurate implementation of medical and claims payment policiesAnalyze claims, operational, and quality performance data to identify trends, risks, and opportunitiesDevelop and present quality performance reports, audit findings, and recommendations to leadershipEnsure accuracy and integrity of quality data, reporting methodologies, and audit documentationPartner with operational leaders to measure effectiveness of improvement initiatives and validate outcomes

Supervisor, Quality Improvement – Minimum Qualifications:

5+ years of healthcare quality improvement, auditing, claims analysis, or related healthcare operations experience2–3 years of supervisory, team lead, or people leadership experienceBachelor's degree in Healthcare Administration, Business, Nursing, Health Information Management, or a related field or equivalent combination of education and relevant experienceStrong knowledge of healthcare claims processing, medical billing, reimbursement methodologies, and medical codingWorking knowledge of ICD-10, CPT, and HCPCS coding principlesExperience conducting quality audits and translating findings into process improvementsStrong analytical and problem-solving skills with high attention to detailAdvanced Microsoft Excel skills and proficiency with Microsoft Office applicationsStrong written, verbal, and presentation skillsAbility to prioritize multiple projects and deadlines in a fast-paced environmentDemonstrated leadership, coaching, and employee development capabilitiesAbility to build effective working relationships across departments

Supervisor, Quality Improvement – Preferred Qualifications:

CPC (Certified Professional Coder), CCS (Certified Coding Specialist), and/or CPMA (Certified Professional Medical Auditor) certifications preferredExperience in a managed care, payer, or healthcare services organizationExperience supporting Quality Improvement or NCQA-related programsLaboratory, genetic testing, or diagnostic management experienceExperience with Power BI, SQL, JIRA, or similar reporting and analytics toolsCertification in Healthcare Quality (CPHQ) preferredClinical, coding, compliance, or health information management background

Equal employment opportunity, including veterans and individuals with disabilities.

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