Note: The job is a remote job and is open to candidates in USA. Inovalon is a technology company focused on transforming the healthcare ecosystem through data-driven solutions. The Senior Clinical Quality Assurance Analyst is responsible for clinical oversight, training, and innovation across the enterprise, ensuring quality improvement and compliance with healthcare standards.
Responsibilities
- 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
Skills
- 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
- 5+ Years with public programs (e.g., Medicare, Medicaid)
Benefits
- Performance-based incentives
- Health insurance
- Life insurance
- Company-paid disability
- 401k
- 18+ days of paid time off
Company Overview