<p>This hybrid Clinical Quality Coordinator role is based in the Orlando, Florida market and sits within a large, value-based primary care organization serving Medicare Advantage patients. The position is the operational engine behind HEDIS and CMS Star Ratings performance — owning medical record review, gap closure, data collection, and quality monitoring across an assigned group of practices. For a healthcare professional with a managed care background and a sharp eye for clinical documentation, this is a high-visibility role with direct impact on patient outcomes and plan performance.</p>
<h3>Perks and Benefits</h3> <ul> <li>Hourly pay range: $20.00 – $36.00 per hour (full-time), determined by local labor market, education, experience, and certifications</li> <li>Comprehensive benefits package including medical, dental, and vision coverage (subject to eligibility requirements)</li> <li>401(k) with employer contribution (subject to eligibility requirements)</li> <li>Employee stock purchase plan / equity program</li> <li>Incentive and recognition programs tied to performance</li> <li>Hybrid work schedule — combination of remote and on-site in the Orlando market</li> <li>Access to career development pathways and internal mobility within a large enterprise</li> </ul>
<h3>Practice Highlights</h3> <ul> <li>Focused on HEDIS and CMS Star Ratings data gathering, quality monitoring, and gap-in-care closure across an assigned group membership</li> <li>Performs medical record reviews to identify Star/HEDIS opportunities and evaluate the quality and completeness of clinical documentation</li> <li>Conducts data collection and data entry in support of health plan form submissions and chart collection activities</li> <li>Partners with leadership on data mining initiatives including group-level, large practice, targeted, and special quality projects</li> <li>Tracks and trends barriers to quality outcomes — including appointment access issues, referral follow-up gaps, and inconsistent billing practices — at assigned provider groups</li> <li>Communicates scheduling challenges or trends that may negatively affect quality performance metrics</li> <li>Supports the chart chase process by requesting records directly from provider offices as needed</li> <li>Assists with local Inter-Rater Reliability (IRR) audits</li> <li>Navigates multiple documentation and EMR systems to extract medical record sections relevant to HEDIS/Star measures</li> <li>Maintains current working knowledge of HEDIS technical specifications and CMS Star measure requirements</li> <li>Value-based, Medicare Advantage-focused patient population with an emphasis on preventive care and chronic disease management</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 interpret data and recommend improvements</li> <li>Proficiency in Microsoft Office applications — including Word, Excel, and database tools — required</li> <li>2+ years of hands-on HEDIS/Star measures experience strongly preferred</li> <li>ICD-10/11 and CPT coding experience preferred</li> <li>EMR experience and familiarity with HEDIS reporting systems preferred</li> <li>Experience with regulatory reporting or similar quality compliance programs preferred</li> <li>Experience in a physician, provider, or medical office setting preferred</li> <li>Required pre-employment screenings: tuberculosis test; documented immunity or vaccination for Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis; drug screening prior to start</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 — with a cost of living that remains accessible relative to other major Sun Belt metros. The region is home to world-class theme parks, a thriving arts and dining scene, and easy access to both Atlantic and Gulf Coast beaches within a two-hour drive. Strong public and private school options, a growing medical corridor, and abundant outdoor recreation make Orlando a compelling destination for healthcare professionals at any career stage.</p>