Senior HEDIS Quality & Audit Analyst

Centene Corporation

Senior HEDIS analyst leading healthcare quality audits and CMS submissions for Centene. Ensuring audit readiness, regulatory compliance, and accurate documentation for health plan operations.

Posted 8/14/2026full-timeRemote • Montana • 🇺🇸 United StatesSenior💰 $70,100 - $126,200 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in HEDIS quality oversight, audit readiness, and regulatory compliance, with a strong focus on risk mitigation and continuous improvement initiatives. Proficient in leading complex NCQA audit workstreams and supporting CMS submission activities.

Highest-signal resume keywords

HEDIS Quality OversightNCQA Audit WorkstreamsRegulatory InterpretationRoot Cause AnalysisCMS Submission Support

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

HEDISQuality AuditsRegulatory RequirementsProject ManagementMeasure SelectionAudit ReadinessRisk MitigationCorrective ActionsPopulation ManagementTesting Validation

Soft Skills

LeadershipCommunicationAnalytical ThinkingProblem SolvingCollaboration

Industry Keywords

NCQACMSHealthcareAuditQuality ImprovementFederal RegulationsState RegulationsCAHPSSubmission RequirementsGovernance Materials

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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