Business Analyst, Quality & Business Performance - Military veterans preferred

About Avalon Healthcare Solutions:

Avalon Healthcare Solutions is the world's first and only Lab Insights company, bringing together our proven Lab Benefit Management solutions, lab science expertise, digitized lab values, and proprietary analytics to help healthcare insurers proactively inform appropriate care, reduce costs, and improve clinical outcomes. Working with health plans nationwide, the company covers over 44+ million lives and delivers 10-20% proven outpatient lab benefit savings. Avalon is pioneering a new era of value-driven care with its Lab Insights Program that captures, digitizes, and analyzes lab results in real-time to provide actionable insights for earlier disease detection, ensuring appropriate treatment protocols and driving down overall costs. 

Avalon is a portfolio company of Francisco Partners, a global private equity firm that specializes in investments in technology and technology-enabled service companies. Avalon is a high growth company where every associate has an opportunity to make a difference. 

Avalon has years of expertise in managing lab benefits and now is leveraging digitized lab results to drive quality clinical outcomes and proven savings.  When you look at how we bring this to life, we offer Lab Insights solutions that work together to arm you with critical lab-driven insights to accelerate your value-driven care success.  This is the first-of-its-kind suite of solutions to help you achieve the Triple Aim of improving the patient experience of care, improving the health of populations, and reducing the per-member cost of healthcare.

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.

About the Business Analyst, Quality & Business Performance:

The Business Analyst will be responsible for analyzing, documenting, and optimizing business processes within the operational performance teams. This role requires a strong understanding of healthcare operations, data analysis, and project management. The ideal candidate will work closely with stakeholders to identify opportunities for improvement and implement effective solutions based on data driven trends and analyses.

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

Business Analyst, Quality & Business Performance – Essential Functions and Responsibilities:

• Design, build, and conduct data analysis across multiple datasets to identify trends, patterns, and opportunities for improvement in healthcare processes.
• Assist in the design and implementation of healthcare IT systems and solutions, ensuring they meet business needs and regulatory requirements.
• Create and deliver presentations and reports to communicate findings, recommendations, and project updates to stakeholders.
• Facilitate workshops and meetings with stakeholders to identify and prioritize business needs and solutions.
• Monitor and evaluate the effectiveness of implemented solutions and make adjustments as necessary.
• Develop and maintain detailed business process documentation, including workflows, data models, and use cases for all analytics performed.
• Stay up-to-date with industry trends, regulations, and best practices in healthcare business analysis.

 Business Analyst, Quality & Business Performance – Minimum Qualifications:

• 3+ years of experience in healthcare operations, authorization or claims, with a focus on quality and business performance processes.
• Bachelor’s degree in Business Administration, Healthcare Management, Information Systems, Health Informatics, or a related field, or 7+ years’ direct, applicable experience in lieu of a degree.
• Strong analytical and problem-solving skills with the ability to interpret complex data and provide actionable insights.
• Proficiency in data analysis tools and software, such as Excel, Tableau, Power BI, SQL, and data visualization tools.
• Knowledge of healthcare regulations, standards, and best practices, including authorization and claims editing systems.
• The ideal candidate is analytical, detail-oriented, and exhibits systems thinking to troubleshoot and improve validation workflows. Experience with healthcare analytics platforms and tools.

 Business Analyst, Quality & Business Performance – Preferred Qualifications:

• Master’s degree in Health Informatics, Information Systems, Healthcare Administration, or a related field.
• Demonstrated expertise in clinical claims editing systems.
• Strong knowledge of regulatory requirements and compliance standards in healthcare, including HIPAA, CMS guidelines, and payer-specific rules.
• Proven track record of process improvement, automation in quality or business performance.