Senior HEDIS Quality & Audit Analyst
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Job Description
Senior HEDIS analyst leading healthcare quality audits and CMS submissions for Centene. Ensuring audit readiness, regulatory compliance, and accurate documentation for health plan operations.
Responsibilities:
- Serve as a senior subject matter expert for HEDIS quality oversight, audit readiness, and submission support activities
- Independently lead complex NCQA audit workstreams, including Roadmaps, Section 5 documentation, measure-specific evidence, CAHPS, and auditor communications
- Interpret and apply federal and state regulatory requirements to HEDIS documentation, workflows, and data use
- Provide expert guidance on reporting population applicability/management, measure selection, and submission requirements
- Identify, assess, and mitigate audit and submission risks
- Lead root cause analysis and develop corrective actions for high-risk or complex issues
- Support CMS submission activities, including PLD coordination, testing validation, and final submission readiness
- Develop, refine, and maintain enterprise standards, templates, controls, and documentation
- Act as an escalation point for complex audit findings, regulatory interpretation questions, and submission decisions
- Contribute to leadership-level reporting, audit narratives, and governance materials
- Drive continuous improvement initiatives to strengthen HEDIS audit readiness and submission accuracy
- Perform other duties as assigned
- Comply with all policies and standards
Requirements:
- Bachelor's Degree in Healthcare or related field, or equivalent experience required
- 4+ years of related experience in HEDIS, Quality Audits, or regulated healthcare environments required
- Project management experience in HEDIS, regulatory, audit, or quality improvement, preferably in a healthcare environment
- Master's Degree in Healthcare or related field preferred
- Must be authorized to work in the U.S. without employment-based visa sponsorship now or in the future
- Ability to independently interpret regulatory and audit requirements
- Knowledge of NCQA and CMS expectations
- Experience with HEDIS quality oversight, audit readiness, and submission support
- Experience with NCQA audit workstreams, Roadmaps, Section 5 documentation, measure-specific evidence, CAHPS, and auditor communications
- Knowledge of federal and state regulatory requirements and state regulations
- Experience with reporting population applicability/management, measure selection, and submission requirements
- Experience identifying and mitigating audit and submission risks
- Experience with root cause analysis and corrective actions
- Experience supporting CMS submissions, PLD coordination, testing validation, and final submission readiness
Benefits:
- competitive pay
- health insurance
- 401K
- 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
- Accommodation support available
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