HEDIS Quality and Audit Analyst
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Job Description
HEDIS Quality and Audit Analyst supporting Centene’s healthcare quality oversight, NCQA audits, and CMS submissions. Ensuring audit-ready documentation, accurate deliverables, and compliant submission timelines.
Responsibilities:
- Support enterprise HEDIS quality oversight, audit readiness, and submission execution activities
- Support NCQA audits and CMS submissions by ensuring documentation and deliverables are complete, accurate, and audit-ready
- Collaborate with Health Plans and cross-functional partners on HEDIS audit and submission timelines and requirements
- Contribute to process improvement through documentation of lessons learned and enhancement opportunities
- Perform NCQA HEDIS audit activities, including preparation and maintenance of Roadmaps, Section 5 documentation, CAHPS, and measure-specific evidence
- Manage audit and submission timelines, deliverables, and dependencies
- Collaborate with Health Plans on reporting population validation and measure selection
- Oversee CMS submission activities, including PLD coordination and submission tracking
- Apply enterprise standards, templates, and documentation requirements across HEDIS audit deliverables
- Identify, document, and escalate audit issues, risks, and documentation gaps
- Lead and participate in audit meetings, working sessions, and internal stakeholder reviews
- Perform quality checks to ensure audit materials are complete, accurate, and defensible
- Comply with all policies and standards and perform other duties as assigned
Requirements:
- Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
- Bachelor's Degree in healthcare or a related field or equivalent experience required
- 2+ years of HEDIS, regulatory, audit, or quality improvement experience, preferably in a healthcare environment required
- Knowledge of NCQA HEDIS audits and CMS submissions
- Ability to prepare and maintain Roadmaps, Section 5 documentation, CAHPS, and measure-specific evidence
- Ability to manage audit and submission timelines, deliverables, and dependencies
- Experience with reporting population validation and measure selection activities
- Ability to coordinate PLD and track CMS submissions
- Ability to apply enterprise standards, templates, and documentation requirements
- Ability to identify, document, and escalate audit issues, risks, and documentation gaps
Benefits:
- Competitive pay
- Health insurance
- 401K plan
- Stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
- Additional forms of incentives may be included in total compensation
- Equal opportunity employer committed to diversity
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