Quality Improvement Data Coordinator - Medicare Advantage

Guidehealth • Decatur, GA

12h • $28 - $32 • Remote

About The Position

As outlined below, provide quality improvement focused work for all delegated entities and support for ACO quality reporting for all contracted ACOs. WHAT YOU’LL BE DOING Work in a partially remote environment, collaborating with team members virtually each day. Serve as a Subject Matter Expert (SME) on quality improvement measures, customer needs, and payer‑specific quality initiatives across commercial and government programs. Travel to provider offices to support quality efforts, including completing on‑site eye exams (training provided), scanning records, and coordinating medical record management. Conduct proactive patient outreach to identify and close quality gaps—educating patients, scheduling screenings, supporting treatment plan adherence, and improving outcomes. Collect and abstract quality data using EMRs, claims information, and provider engagement. Use multiple platforms daily, including EMR systems, payer portals, vendor tools, GuideHealth applications, and Microsoft 365 (Excel, Word, PowerPoint, Teams). Work with various health data sources, including patient lists, gap lists, and medical records. Apply all available quality resources—NCQA/HEDIS® specifications, coding materials, and Guides—to ensure accuracy and completeness. Prioritize tasks to meet strict reporting timelines and quality program requirements. Communicate performance trends, barriers, and improvement strategies to internal teams and external partners. Follow established QI workflows, processes, and best practices. Collaborate daily with customers, payers, and internal teams. Participate in payer and departmental trainings, webinars, and support calls. Represent GuideHealth professionally and build positive working relationships with providers and staff.

Requirements

• Associate degree or higher, or a clinical license/certification (CMA, LPN).
• 1–3 years of healthcare experience , including EMR use, medical terminology, chart review, and familiarity with quality measures or billing/coding.
• Minimum 2 years of Medicare Advantage quality data abstraction and patient outreach experience.
• Strong technical ability—comfortable working with health data, Excel, PowerPoint, and multiple digital systems.
• Excellent verbal and written communication skills.
• High attention to detail, strong organization, and the ability to meet strict deadlines.
• Ability to work collaboratively across teams and with external partners.
• Valid driver’s license and personal vehicle; travel required and reimbursed.

Nice To Haves

• Certified/licensed professional-CMA, LPN
• Knowledge or experience in quality improvement initiatives and data submissions required by various health insurance payers.
• Extensive experience with quality database entries and reporting.
• Experience in interpreting and reporting quality information, as well as training staff.
• Proficiency in Electronic Medical Record (EMR) software and cloud platforms

Responsibilities

• Work in a partially remote environment, collaborating with team members virtually each day.
• Serve as a Subject Matter Expert (SME) on quality improvement measures, customer needs, and payer‑specific quality initiatives across commercial and government programs.
• Travel to provider offices to support quality efforts, including completing on‑site eye exams (training provided), scanning records, and coordinating medical record management.
• Conduct proactive patient outreach to identify and close quality gaps—educating patients, scheduling screenings, supporting treatment plan adherence, and improving outcomes.
• Collect and abstract quality data using EMRs, claims information, and provider engagement.
• Use multiple platforms daily, including EMR systems, payer portals, vendor tools, GuideHealth applications, and Microsoft 365 (Excel, Word, PowerPoint, Teams).
• Work with various health data sources, including patient lists, gap lists, and medical records.
• Apply all available quality resources—NCQA/HEDIS® specifications, coding materials, and Guides—to ensure accuracy and completeness.
• Prioritize tasks to meet strict reporting timelines and quality program requirements.
• Communicate performance trends, barriers, and improvement strategies to internal teams and external partners.
• Follow established QI workflows, processes, and best practices.
• Collaborate daily with customers, payers, and internal teams.
• Participate in payer and departmental trainings, webinars, and support calls.
• Represent GuideHealth professionally and build positive working relationships with providers and staff.

Benefits

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree