HEDIS & CMS Stars Quality Specialist I

Astrana Health Management; Monterey Park (CA); Hybrid; USD 34,000 - 41,000; Full time

Job summary

Astrana Health is seeking a QCI Specialist I to support quality initiatives across our Southern California IPAs. This role partners with practices to boost HEDIS and CMS Star metrics, reviews medical records for reporting, analyzes performance data, and delivers education and training on quality measures and documentation standards.

The position reports to the Quality department and offers a hybrid in-office/remote schedule in Monterey Park, CA, with up to 25% travel to provider offices.

Qualifications

• Bachelor’s degree or equivalent experience.
• 3–5 years in healthcare, IPA/MSO/Health Plan environment.
• Minimum of 1 year of HEDIS-related experience.
• Independent transportation and 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.
• Fluent in Spanish and/or Chinese (Mandarin/Cantonese) is a plus.

Responsibilities

• Partner with provider practices to improve performance on quality care measures, focusing on practice transformation and population health management.
• 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.
• Provide in-service training to PCPs and office staff on quality metrics, incentive programs, and documentation integrity.
• Support project implementation aimed at enhancing service delivery, patient outcomes, and care experience.
• Guide practices through sustainable process improvements, including team building, leadership development, and operational redesign.
• Act as a subject matter expert on CMS, HEDIS, NCQA, HIPAA, and health plan standards.
• Conduct comprehensive training for PCPs and specialists on: 1) Quality Measures 2) HEDIS and CMS Star Ratings 3) Performance-Based Incentive Programs 4) Data Accuracy and Documentation Standards
• Perform additional duties and projects as assigned

Skills

Quality improvement

HEDIS

CMS Star Ratings

Population health

Data analysis

Training

Documentation

CMS/NCQA/HIPAA

Education

Bachelor's degree

Job description

Astrana Health is seeking a QCI Specialist I to support quality initiatives across our Southern California IPAs. This role partners with practices to boost HEDIS and CMS Star metrics, reviews medical records for reporting, analyzes performance data, and delivers education and training on quality measures and documentation standards.

The position reports to the Quality department and offers a hybrid in-office/remote schedule in Monterey Park, CA, with up to 25% travel to provider offices.