QCI Specialist I

Astrana Health, Inc.•Monterey Park, CA

1d•$26 - $33•Hybrid

About The Position

This 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.

Requirements

Bachelor’s degree or equivalent experience
3–5 years of experience in healthcare, ideally in IPA/MSO/Health Plan environments
Minimum of 1 year of HEDIS-related experience
Independent transportation and ability to travel up to 25% as needed
Strong knowledge of managed care and quality program standards
Excellent analytical, communication, and presentation skills
Demonstrates initiative, creativity, and a collaborative mindset

Nice To Haves

Fluent in Spanish and/or Chinese (Mandarin/Cantonese)
Familiar with practice management and financial operations
Are adaptable, self-motivated, and eager to grow within a mission-driven organization
Highly organized, detail-oriented, and capable of managing multiple priorities in a dynamic environment
Experienced in outpatient clinical settings

Responsibilities

Serve as a quality performance resource to assigned health plan partners, provider groups, clinics, and MSOs, providing and presenting HEDIS performance scorecards monthly
Conduct targeted member outreach to support strategic initiatives and campaigns aimed at improving performance metrics for health plans and provider offices
Collaborate with assigned health plans and/or provider offices to improve documentation, coding accuracy, and care gap closure
Collect, review, validate and attest medical records to ensure accuracy and completeness for reporting purposes
Analyze provider performance data, identify trends, and deliver targeted education to drive improvements
Support monthly supplemental data submission, file preparation, and verification of compliant coding
Work with internal teams and vendors to validate, reconcile, and audit HEDIS records to ensure completeness and accuracy
Prepare reports, scorecards, and presentations for leadership review
Obtain data needed for Primary Source Verification audits from health plans and vendors and ensure timely submission
Provide in-service training to primary care providers and office staff on quality metrics, incentive programs, and documentation integrity
Act as a subject matter expert on CMS, HEDIS, NCQA, HIPAA, and health plan standards
Lead end-to-end quality improvement projects on HEDIS, CMS Stars, and regulatory compliance
Conduct comprehensive training for PCPs and specialists on: Quality Measures HEDIS and CMS Star Ratings Performance-Based Incentive Programs Data Accuracy and Documentation Standards
Other duties as assigned.