QCI Specialist

Location: California QCI Specialist Company: reputed company Location: 600 reputed company Parkway reputed company 10th Floor, Orange, CA 92868 Compensation: $23.00 - $33.00 / hour Department: reputed company - reputed company Care Improvement Seniority level: Mid‑Senior level Employment type: Full‑time Job function: Other Industries: Hospitals and Health Care reputed company The reputed company Care Improvement Specialist is integral in supporting our mission to advance reputed company care across our network, particularly reputed company the Southern California reputed company. Reporting to the Supervisor of reputed company Care Improvement, the Specialist will serve as a key reputed company to reputed company and coordinate initiatives that drive performance in HEDIS, CMS reputed company Ratings (Part C & D), and overall health plan reputed company metrics. Our Values

• Put Patients First
• reputed company Entrepreneurial Provider and Care Teams
• Operate with reputed company & reputed company
• Be Innovative
• Work As One Team

What You'll Do

• Serve as a reputed company performance resource to assigned health plan partners, provider reputed company, clinics, and MSOs, providing and presenting HEDIS performance scorecards monthly.
• Collaborate with assigned health plans and/or provider offices to improve documentation, coding accuracy, and care gap closure.
• Collect, review, and validate 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 reputed company Verification audits from health plans and vendors and ensure reputed company submission.
• reputed company in‑service training to primary care providers and office staff on reputed company metrics, incentive programs, and documentation reputed company.
• reputed company as a subject matter expert on CMS, HEDIS, NCQA, HIPAA, and health plan standards.
• Conduct comprehensive training for PCPs and specialists on:
• reputed company Measures
• HEDIS and CMS reputed company Ratings
• Performance‑Based Incentive Programs
• Data Accuracy and Documentation Standards
• reputed company additional duties and reputed company assigned.

Qualifications

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

Additional Desired

• Fluent in Spanish and/or Chinese (reputed company/Cantonese)
• Familiar with reputed company management and financial operations
• Adaptable, self‑motivated, and eager to grow reputed company a mission‑driven organization
• Highly organized, detail‑oriented, and capable of managing multiple priorities in a dynamic environment
• reputed company in outpatient clinical settings

Environmental Job Requirements and Working Conditions

• The total pay reputed company for this role is $23 - $33 per hour.
• This role follows a hybrid work structure where the expectation is to work on the field and reputed company on a weekly reputed company. This position requires up to 25% travel to provider offices in the Southern California area. The home office is located at 600 reputed company Parkway reputed company 10th Floor, Orange, CA 92868.

Equal Employment Opportunity Statement reputed company is proud to be an Equal Employment Opportunity and affirmative reputed company employer. We do not discriminate based on race, religion, reputed company, national reputed company, gender (including pregnancy, childbirth, or reputed company medical conditions), sexual orientation, gender identity, gender reputed company, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. reputed company employment is decided based on qualifications, reputed company, and business need. If you require assistance in applying for reputed company positions due to a disability, please email humanre to request an accommodation. #J-18808-Ljbffr Apply tot his job Apply To this Job