[Hiring] Senior HEDIS Quality & Audit Analyst @Centene Corporation
Role Description
The Senior HEDIS Quality & Audit Analyst serves as an enterprise subject matter expert responsible for advanced HEDIS quality oversight, audit readiness, and submission support activities. This role independently interprets regulatory and audit requirements, leads complex HEDIS audit workstreams, and ensures accurate, timely, and audit-defensible documentation and submissions in alignment with NCQA and CMS expectations.
ā¢ Serve as a senior subject matter expert for HEDIS quality oversight, audit readiness, and submission support activities.
ā¢ Independently lead complex NCQA audit workstreams, including Roadmaps, Section 5 documentation, measure-specific evidence, CAHPS, and auditor communications.
ā¢ Interpret and apply federal and state regulatory requirements, and applicable state regulations, to HEDIS documentation, workflows, and data use.
ā¢ Provide expert guidance on reporting population applicability/management, measure selection, and submission requirements.
ā¢ Identify, assess, and mitigate audit and submission risks; lead root cause analysis and development of corrective actions for high-risk or complex issues.
ā¢ Support CMS submission activities, including PLD coordination, testing validation, and final submission readiness.
ā¢ Develop, refine, and maintain enterprise standards, templates, controls, and documentation to ensure audit-defensible outcomes.
ā¢ Act as an escalation point for complex audit findings, regulatory interpretation questions, and submission decisions.
ā¢ Contribute to leadership-level reporting, audit narratives, and governance materials.
ā¢ Drive continuous improvement initiatives to strengthen HEDIS audit readiness and submission accuracy.
ā¢ Performs other duties as assigned.
ā¢ Complies with all policies and standards.
Qualifications
ā¢ Bachelor's Degree in Healthcare or related field, or equivalent experience required.
ā¢ Master's Degree in Healthcare or related field preferred.
ā¢ 4+ years of related experience in HEDIS, Quality Audits, or regulated healthcare environments required.
ā¢ Project management experience in HEDIS, regulatory, audit, or quality improvement experience, preferably in a healthcare environment preferred.
ā¢ LTSS experience highly preferred.
Requirements
ā¢ Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
ā¢ Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
Benefits
ā¢ Competitive pay
ā¢ Health insurance
ā¢ 401K and stock purchase plans
ā¢ Tuition reimbursement
ā¢ Paid time off plus holidays
ā¢ Flexible approach to work with remote, hybrid, field, or office work schedules
Apply tot his job
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The Senior HEDIS Quality & Audit Analyst serves as an enterprise subject matter expert responsible for advanced HEDIS quality oversight, audit readiness, and submission support activities. This role independently interprets regulatory and audit requirements, leads complex HEDIS audit workstreams, and ensures accurate, timely, and audit-defensible documentation and submissions in alignment with NCQA and CMS expectations.
ā¢ Serve as a senior subject matter expert for HEDIS quality oversight, audit readiness, and submission support activities.
ā¢ Independently lead complex NCQA audit workstreams, including Roadmaps, Section 5 documentation, measure-specific evidence, CAHPS, and auditor communications.
ā¢ Interpret and apply federal and state regulatory requirements, and applicable state regulations, to HEDIS documentation, workflows, and data use.
ā¢ Provide expert guidance on reporting population applicability/management, measure selection, and submission requirements.
ā¢ Identify, assess, and mitigate audit and submission risks; lead root cause analysis and development of corrective actions for high-risk or complex issues.
ā¢ Support CMS submission activities, including PLD coordination, testing validation, and final submission readiness.
ā¢ Develop, refine, and maintain enterprise standards, templates, controls, and documentation to ensure audit-defensible outcomes.
ā¢ Act as an escalation point for complex audit findings, regulatory interpretation questions, and submission decisions.
ā¢ Contribute to leadership-level reporting, audit narratives, and governance materials.
ā¢ Drive continuous improvement initiatives to strengthen HEDIS audit readiness and submission accuracy.
ā¢ Performs other duties as assigned.
ā¢ Complies with all policies and standards.
Qualifications
ā¢ Bachelor's Degree in Healthcare or related field, or equivalent experience required.
ā¢ Master's Degree in Healthcare or related field preferred.
ā¢ 4+ years of related experience in HEDIS, Quality Audits, or regulated healthcare environments required.
ā¢ Project management experience in HEDIS, regulatory, audit, or quality improvement experience, preferably in a healthcare environment preferred.
ā¢ LTSS experience highly preferred.
Requirements
ā¢ Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
ā¢ Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
Benefits
ā¢ Competitive pay
ā¢ Health insurance
ā¢ 401K and stock purchase plans
ā¢ Tuition reimbursement
ā¢ Paid time off plus holidays
ā¢ Flexible approach to work with remote, hybrid, field, or office work schedules
Apply tot his job
Apply To this Job