QCI Specialist I

QCI Specialist IDepartment: Quality - Quality Care ImprovementEmployment Type: Full TimeLocation: 600 City Parkway West 10th Floor, Orange, CA 92868Reporting To: Celine PhanCompensation: $25.71 - $32.99 / hourDescriptionThis role is integral in supporting our mission to advance quality care across our network, particularly within the Southern California IPAs. Reporting to the Supervisor of Quality Care Improvement, the Specialist will serve as a key liaison to lead and coordinate initiatives that drive performance in HEDIS, CMS Star Ratings (Part C & D), and overall health plan quality metrics.What You'll DoServe as a quality performance resource to assigned health plan partners, provider groups, clinics, and MSOs, providing and presenting HEDIS performance scorecards monthlyConduct targeted member outreach to support strategic initiatives and campaigns aimed at improving performance metrics for health plans and provider officesCollaborate with assigned health plans and/or provider offices to improve documentation, coding accuracy, and care gap closureCollect, review, validate and attest medical records to ensure accuracy and completeness for reporting purposesAnalyze provider performance data, identify trends, and deliver targeted education to drive improvementsSupport monthly supplemental data submission, file preparation, and verification of compliant codingWork with internal teams and vendors to validate, reconcile, and audit HEDIS records to ensure completeness and accuracyPrepare reports, scorecards, and presentations for leadership reviewObtain data needed for Primary Source Verification audits from health plans and vendors and ensure timely submissionProvide in-service training to primary care providers and office staff on quality metrics, incentive programs, and documentation integrityAct as a subject matter expert on CMS, HEDIS, NCQA, HIPAA, and health plan standardsLead end-to-end quality improvement projects on HEDIS, CMS Stars, and regulatory complianceConduct comprehensive training for PCPs and specialists on:Quality MeasuresHEDIS and CMS Star RatingsPerformance-Based Incentive ProgramsData Accuracy and Documentation StandardsOther duties as assignedQualificationsBachelor's degree or equivalent experience3-5 years of experience in healthcare, ideally in IPA/MSO/Health Plan environmentsMinimum of 1 year of HEDIS-related experienceIndependent transportation and ability to travel up to 25% as neededStrong knowledge of managed care and quality program standardsExcellent analytical, communication, and presentation skillsDemonstrates initiative, creativity, and a collaborative mindsetYou're great for the role if you are:Fluent in Spanish and/or Chinese (Mandarin/Cantonese)Familiar with practice management and financial operationsAre adaptable, self-motivated, and eager to grow within a mission-driven organizationHighly organized, detail-oriented, and capable of managing multiple priorities in a dynamic environmentExperienced in outpatient clinical settingsEnvironmental Job Requirements and Working ConditionsThe total pay range for this role is $25.71 - $32.99 per hour. This salary range represents our national target range for this role.This role follows a hybrid work structure where the expectation is to work on the field and at home on a weekly basis. The home office is located at 600 City Parkway West 10th Floor, Orange, CA 92868.This position requires up to 25% travel to provider offices in the Inland Empire area.Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.