The Quality Support Analyst 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.
Key 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.
Minimum Qualifications
• Previous experience working in a health plan or healthcare services organization.
• Strong analytical and problem-solving skills with the ability to work effectively in environments with shifting priorities.
• Demonstrated ownership and accountability for deliverables and outcomes.
• Excellent written and verbal communication skills with strong attention to detail in documentation and reporting.
• Working knowledge of SQL for developing and executing queries.
• Advanced proficiency in Microsoft Office Suite, particularly Excel.
• Strong organizational skills and attention to detail.
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.