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Senior HEDIS Quality & Audit Analyst
Location
Florida
Posted
83 days ago
Salary
$70.1K - $126.2K / year
Seniority
Senior
Job Description
Senior HEDIS Quality & Audit Analyst
Centene Corporation
• 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, and applicable state regulations, 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 development of 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 to ensure audit-defensible outcomes. • 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. • Performs other duties as assigned. Complies with all policies and standards.
Job Requirements
- Bachelor's Degree Healthcare or related field, or equivalent experience required
- Master's Degree Healthcare or related field preferred
- 4+ years related experience in HEDIS, Quality Audits, or regulated healthcare environments required
- Project management experience in HEDIS, regulatory, audit, or quality improvement experience, preferably in a healthcare environment preferred
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
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