Job Summary We are looking for a motivated, detail-oriented professional to join our team as a Quality Improvement Specialist. This entry-level role is a fantastic gateway into healthcare administration and population health. You will focus on improving clinical outcomes and star ratings for our Medicare Part A, C, and D programs. Your primary mission will be to support HEDIS (Healthcare Effectiveness Data and Information Set) initiatives by ensuring accurate data collection, identifying gaps in patient care, and collaborating with provider offices to improve the quality of care our members receive.

Duties HEDIS Data Support:

Assist in the annual HEDIS data collection process, including medical record retrieval and basic abstraction for Part C and D measures.

Gap Closure:

Monitor reports to identify members with "gaps in care" (e.g., missing screenings or vaccinations) and work on initiatives to encourage compliance.

Provider Outreach:

Act as a point of contact for provider offices to educate them on documentation requirements and collect necessary clinical data.

Part D Pharmacy Quality:

Support measures related to medication adherence and safety, ensuring members are following prescribed therapies.

Compliance & Privacy:

Maintain strict adherence to HIPAA regulations while handling sensitive patient health information (PHI).

Reporting:

Assist in preparing weekly progress reports on outreach efforts and measure-specific performance.

Experience Education:

Medical Assistant Certification, High School Diploma or GED Technical Skills:

Proficiency in Microsoft Excel (sorting, filtering, and basic formulas) and an aptitude for learning Electronic Health Record (EHR) systems.

Communication:

Strong verbal and written communication skills—you'll be talking to a lot of medical office staff!

Language:

English & Spanish Required!

Analytical Mindset:

A natural curiosity for "the why" behind the data and a high level of attention to detail..

Knowledge Base:

(Preferred but not required) Basic familiarity with

Medicare, HEDIS, Pay:

$13.50 - $14.00 per hour

Benefits:

401(k) 401(k) matching Employee discount Health insurance Life insurance Paid time off Referral program Retirement plan

Work Location:

In person