Senior Clinical Quality Assurance Analyst

Location

This position is designated as remote. However, employees who reside within a 40-mile radius of one of our office locations in Tampa, FL; Canonsburg, PA; or Bowie, MD will follow a hybrid work schedule and are expected to work in the office two days per week (Tuesdays and Wednesdays).

Job Description

The Senior Clinical Quality Assurance Analyst is responsible for clinical oversight, training, and innovation across the enterprise.

Essential Functions

• Assist with the development, organization, and implementation of companywide quality improvement efforts;
• Monitor the quality and reliability of reporting mechanisms and management tools;
• Perform analysis of reviews and lead consolidation of findings for reporting to senior leadership and other key stakeholders;
• Ensure compliance with contractual, local, state, and national quality standards;
• Support current and future clinical product strategy through competitive research analysis, peer-group comparisons, product and clinical research and development, human resource requirements, and market opportunity analysis;
• Support clinical product implementations to include ensuring designated clinical projects and their respective stage of development is met on time, within budget, and according to written requirement specifications;
• Assist with the development and successful execution of Inovalon's training processes (both initial and ongoing training);
• Maintain open lines of communication across the enterprise regarding on-going overread and quality activity as it relates to client and operations management;
• Develop recommendations for process and technical changes; document changes as applicable;
• Assist in the development, execution, and management of internal and client facing clinical auditing programs;
• Assist with client relationships across the Company's quality management services while also supporting, nurturing, and expanding successful client relationships;
• Assist in resolution of client questions, concerns, and service issues working closely with other key stakeholders to create and execute action plans;
• Support organization's cross functional teams using exceptional clinical and business skills;
• Develop new policies, processes, and procedures in line with clinical and organizational expectations;

Qualifications

• Minimum 2 years of ICD-10 diagnosis coding expertise (ideally 5+ years); deep understanding of coding guidelines and their application
• Minimum 2 years of HEDIS quality measure experience; understanding of HEDIS rules, regulations, and hybrid measure development
• Risk adjustment coding expertise; understanding of risk adjustment methodologies and coding accuracy
• Hands-on experience with AI tools or AI training background; demonstrated ability to understand AI capabilities and limitations
• 5+ Years clinical nursing background
• 5+ Years in healthcare plan quality improvement initiatives preferred
• 5+ Years with public programs