QCI Specialist I

Job description

QCI Specialist I Department: Quality - Quality Care Improvement Employment Type: Full Time: Location: 600 City Parkway West 10th Floor, Orange, CA 92868 Reporting To: Celine Phan: Compensation: $25.71 - $32.99 / hour Description: 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. What You'll Do: - 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 purpo...