Quality Improvement Data Coordinator Medicare Advantage

Job Description

As outlined below, provide quality improvement focused work for all delegated entities and support for ACO quality reporting for all contracted ACOs.

• Work in a partially remote environment, collaborating with team members virtually each day.
• Serve as a Subject Matter Expert (SME) on quality improvement measures, customer needs, and payer‑specific quality initiatives across commercial and government programs.
• Travel to provider offices to support quality efforts, including completing on‑site eye exams (training provided), scanning records, and coordinating medical record management.
• Conduct proactive patient outreach to identify and close quality gaps—educating patients, scheduling screenings, supporting treatment plan adherence, and improving outcomes.
• Collect and abstract quality data using EMRs, claims information, and provider engagement.
• Use multiple platforms daily, including EMR systems, payer portals, vendor tools, Guide Health applications, and Microsoft 365 (Excel, Word, PowerPoint, Teams).
• Work with various health data sources, including patient lists, gap lists, and medical records.
• Apply all available quality resources—NCQA/HEDIS® specifications, coding materials, and Guides—to ensure accuracy and completeness.
• Prioritize tasks to meet strict reporting timelines and quality program requirements.
• Communicate performance trends, barriers, and improvement strategies to internal teams and external partners.
• Follow established QI workflows, processes, and best practices.
• Collaborate daily with customers, payers, and internal teams.
• Participate in payer and departmental trainings, webinars, and support calls.
• Represent Guide Health professionally and build positive working relationships with providers and staff.

• Associate degree or higher, or a clinical license/certification (CMA, LPN).
• 1–3 years of healthcare experience
  , including EMR use, medical terminology, chart review, and familiarity with quality measures or billing/coding.
• Minimum 2 years of Medicare Advantage quality data abstraction and patient outreach experience.
• Strong technical ability—comfortable working with health data, Excel, PowerPoint, and multiple digital systems.
• Excellent verbal and written communication skills.
• High attention to detail, strong organization, and the ability to meet strict deadlines.
• Ability to work collaboratively across teams and with external partners.
• Valid driver’s license and personal vehicle; travel required and reimbursed.

• Certified/licensed professional-CMA, LPN
• Knowledge or experience in quality improvement initiatives and data submissions required by various health insurance payers.
• Extensive experience with quality database entries and reporting.
• Experience in interpreting and reporting quality information, as well as training staff.
• Proficiency in Electronic Medical Record (EMR) software and cloud platforms

• Use your skills to make a meaningful impact in healthcare.
• Work with a great team in an awesome work environment.
• Competitive compensation.
• Great benefits like flextime time off.

The base pay range for this role is between $28-$32 per hour paid bi-weekly

At Guidehealth, our values come to life in everything we do.

• We are Driven by A accountability — grounded in transparency, reliability, and integrity as we navigate challenges and opportunities alike.
• Always Growing, Always L earning — staying curious and continuously improving inspires us to shape a better future for healthcare.
• With Collaborative I nnovation, we solve problems creatively, making every experience better for our employees and the patients we serve.
• At Guidehealth, Every V oice Matters — we believe our collective strength is rooted in the unique perspectives of each team member.
• And through E mpathy in Action, we build stronger connections with those who count on us.
• This is what it means to be ALIVE with purpose. This is how we thrive — together — at Guidehealth.

While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need…