<p>This hybrid Clinical Quality Coordinator role is based in Orlando, Florida, embedded within a large managed care organization serving Medicare Advantage patients across the WellMed network. The position sits at the intersection of HEDIS/STARs data integrity and clinical documentation improvement — a high-visibility function that directly influences quality ratings and care gap closure outcomes. Candidates who thrive in data-driven, cross-functional environments and have hands-on experience with medical record review and quality monitoring will find meaningful, measurable impact here.</p>
<h3>Perks and Benefits</h3> <ul> <li>Hourly pay range of $20.00 – $36.00, based on education, experience, certifications, and local labor market factors</li> <li>Comprehensive benefits package including medical, dental, and vision coverage (subject to eligibility requirements)</li> <li>401(k) with company contribution (subject to eligibility requirements)</li> <li>Employee stock purchase plan with equity participation</li> <li>Incentive and recognition programs tied to performance</li> <li>Hybrid work arrangement — combination of remote and on-site in Orlando</li> <li>Access to career development pathways and internal role advancement opportunities</li> </ul>
<h3>Practice Highlights</h3> <ul> <li>Coordinates HEDIS and STARs data gathering processes across assigned provider groups, large practices, and targeted special projects</li> <li>Performs quality medical record reviews to evaluate completeness and accuracy of clinical documentation against HEDIS/STARs technical specifications</li> <li>Supports chart chase activities — requesting records from provider offices and managing chart collection workflows to close gaps in care</li> <li>Partners with leadership on data mining initiatives focused on group-level and population-level quality outcomes</li> <li>Tracks and trends barriers at assigned groups including appointment access issues, referral follow-up gaps, and inconsistent billing practices</li> <li>Navigates multiple documentation and EMR systems to extract medical record sections relevant to specific HEDIS/STARs measures</li> <li>Assists with local Inter-Rater Reliability (IRR) audits to ensure consistency and accuracy in review processes</li> <li>Communicates scheduling challenges and emerging trends that may negatively affect quality outcomes to the leadership team</li> <li>Maintains ongoing education and knowledge base in HEDIS/STARs measure updates and regulatory reporting requirements</li> <li>Operates within a managed care environment serving a small group membership with a focus on Medicare Advantage quality performance</li> </ul>
<h3>Qualifications</h3> <ul> <li>High School diploma or GED required; 2+ years of college coursework toward a bachelor's or associate degree preferred</li> <li>Minimum 3 years of healthcare experience, including direct experience in a managed care setting</li> <li>Minimum 3 years of experience with data analysis and quality chart reviews, with demonstrated ability to identify trends and recommend improvements</li> <li>Proficiency in Microsoft Office applications including Word, Excel, and database tools</li> <li>2+ years of direct HEDIS/STARs experience preferred; familiarity with similar regulatory reporting frameworks a plus</li> <li>ICD-10/11 and CPT coding knowledge preferred</li> <li>EMR experience preferred; experience in a physician, provider, or medical office setting a plus</li> <li>Must pass a pre-employment drug screening</li> </ul>
<h3>About the Community</h3> <p>Orlando, Florida offers a year-round warm climate, no state income tax, and one of the most dynamic metropolitan economies in the Southeast — making it an attractive base for healthcare professionals at any career stage. Beyond the theme parks and tourism economy, Orlando features a rapidly expanding medical corridor, diverse neighborhoods, strong public and private school options, and easy access to both Atlantic and Gulf Coast beaches within a two-hour drive. The cost of living remains competitive relative to other major Florida metros, and the city's international airport provides convenient connectivity for those who travel frequently.</p>