QCI 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

QCI Specialist I

Department: Quality

Employment Type: Full Time

Location: 1600 Corporate Center Dr., Monterey Park, CA 91754

Reporting To: Lia Bekijanian

Compensation: $25.00 - $30.00 / 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

• 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 primary care providers 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

Qualifications

• 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

You're great for the role if you are:

• 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

Environmental Job Requirements and Working Conditions

• Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The home office is located at 1600 Corporate Center Drive, Monterey Park, CA 91754.
• This position requires up to 25% travelto provider offices in the San Gabriel Valley area.
• The total compensation target pay range for this role is between $25.00 - $30.00 per hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.

Astrana Health is proud to be an Equal Employment Opportunity and affirmative action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at [e-mail] to request an accommodation.

Additional Information: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.