Senior HEDIS Quality & Audit Analyst
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: Florida • United States
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Salary
💰 $70,100 - $126,200 per year
Job Level
About the role
- 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.
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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
HEDISNCQA auditregulatory interpretationroot cause analysiscorrective actionssubmission supportquality auditsproject managementdata managementcontinuous improvement
Soft Skills
leadershipcommunicationproblem-solvinganalytical thinkingrisk assessmentcollaborationguidancereportingescalation managementinitiative