Hcc Qa Jobs (NOW HIRING)

The VBC / Quality Strategist is a client-facing expert within Saisystems Health's Customer Success Consulting Practice, specializing in value-based care program strategy, quality measure performance, and clinical quality improvement for provider organization clients. This role helps clients navigate the transition from fee-for-service to value-based reimbursement improving quality scores, closing care gaps, optimizing risk adjustment, and maximizing performance under ACO, MSSP, PCMH, and payer-specific quality programs.

Partnering with RCM, PacEHR, Payor Enrollment, and Compliance specialists, the VBC / Quality Strategist ensures that clients' quality and value-based initiatives are fully integrated with their revenue cycle and clinical documentation workflows. This is a high-impact advisory role that sits at the intersection of clinical performance, financial incentives, and regulatory compliance.

KEY RESPONSIBILITIES

Value-Based Care Strategy & Quality Advisory

Serve as the primary VBC and quality consulting expert for an assigned portfolio of clients, providing advisory support across quality measure performance, care gap closure, risk adjustment, and value-based contract strategy.

Assess client performance across key quality programs including HEDIS, STARS, Merit-Based Incentive Payment System (MIPS), alternative payment models (APMs), ACO/MSSP, and payer-

specific value-based contracts and deliver improvement roadmaps with clear performance targets.

Advise clients on care gap identification and closure workflows, integrating quality measure requirements into clinical workflows, EHR documentation, and population health management processes.

Guide clients in building and executing risk adjustment strategies including HCC coding accuracy, chronic condition documentation, and Annual Wellness Visit programs to ensure appropriate risk capture and reimbursement.

Support clients in PCMH recognition, ACO participation strategy, and quality-based payer contract negotiations, providing expert guidance on program requirements and performance benchmarks.

Quality Analytics & Performance Reporting

Develop and deliver quality performance dashboards and operational reports tailored to client clinical and executive leadership, translating complex measure data into clear priorities and action plans.

Conduct HEDIS and STARS gap analyses, model performance scenarios, and identify the highest-impact interventions for improving client quality scores.

Monitor client performance against quality benchmarks, value-based contract targets, and regulatory thresholds providing proactive alerts and structured recommendations.

Lead periodic quality performance reviews with client stakeholders, presenting trends, wins, risks, and next-period priorities in an executive-friendly format.

Client & Stakeholder Engagement

Lead client-facing advisory sessions, quarterly business reviews, and quality strategy planning meetings with CMOs, quality directors, population health teams, and executive leadership.

Proactively communicate CMS quality program updates, HEDIS measure changes, payer quality contract amendments, and regulatory developments affecting client performance and reimbursement.

Build and maintain strong client relationships, serving as a trusted advisor on all quality and VBC matters and escalating issues proactively when performance risks are identified.

Cross-Team Collaboration & Practice Growth

Partner with Account Managers to identify quality and VBC-related expansion opportunities within existing client accounts.

Collaborate with PacEHR specialists to ensure EHR configurations support quality measure documentation, care gap alerting, and population health workflows.

Work with RCM specialists on risk adjustment workflows and the intersection of HCC coding and revenue cycle operations.

Contribute to the VBC/Quality practice library including measure implementation guides, care gap closure playbooks, and quality improvement templates.

KEY PERFORMANCE INDICATORS

Client improvement in HEDIS, STARS, and MIPS scores vs. prior-period baseline

Care gap closure rates across client populations

HCC recapture and risk score improvement for applicable client programs

Client satisfaction scores and retention in assigned accounts

Timeliness and quality of client quality performance reports and deliverables

Expansion revenue attributable to VBC/Quality practice referrals and recommendations

QUALIFICATIONS

Education

Bachelor's degree in Healthcare Administration, Public Health, Clinical Sciences, Health Informatics, or a related field or equivalent professional experience.

CPHQ (Certified Professional in Healthcare Quality), RHIA, or equivalent quality or health informatics certification preferred.

Experience

58+ years of experience in healthcare quality improvement, value-based care, population health management, or managed care operations.

3+ years in a client-facing, consulting, or advisory role supporting provider organizations in VBC or quality program strategy.

Strong working knowledge of HEDIS measures, CMS STARS methodology, MIPS/APM participation requirements, ACO/MSSP program structure, and HCC risk adjustment.

Experience with quality performance analytics tools, population health platforms, and EHR-based quality reporting workflows.

Familiarity with PCMH recognition requirements, value-based payer contracting, and clinical quality improvement methodologies (e.g., PDSA, Lean).

Skills & Competencies

Deep knowledge of healthcare quality programs, value-based payment models, risk adjustment methodologies, and clinical quality improvement frameworks.

Strong analytical skills able to interpret measure-level performance data, model improvement scenarios, and identify the highest-leverage interventions.

Excellent communication and presentation skills; able to translate complex quality metrics into clear, actionable guidance for clinical and executive audiences.

Ability to manage multiple client engagements simultaneously, navigate complex program requirements, and deliver results in a fast-paced environment.

Consultative mindset brings structure, accountability, and creative problem-solving to quality improvement challenges across diverse client environments.

WORK ENVIRONMENT

This is a Hybrid role with regular client-facing engagements including quality reviews, population health strategy sessions, quarterly business reviews, and occasional team gatherings. You will operate as part of the Saisystems Health Customer Success Consulting Practice, collaborating daily with Account Managers, fellow practice strategists, and the Director of Customer Success.

ORGANIZATIONAL RELATIONSHIPS

This role develops and maintains strong working relationships with:

Director of Customer Success and Consulting Practice leadership

Account Management team for client expansion and escalation coordination

Fellow Consulting Practice specialists (RCM, PacEHR, Payor Enrollment, CMP)

Client CMOs, quality directors, population health teams, and payer relations contacts

CMS, NCQA, payer quality program managers (on behalf of clients)

Sales team for pre-sales support and new engagement scoping