HEDIS Audit Quality Lead (Hybrid)

Elevance Health; Grand Prairie (TX); Hybrid; USD 99,000 - 163,000; Full time

Benefits offered by this job

Comprehensive benefits

Stock purchase plan

401k matching

Job summary

Elevance Health is seeking a HEDIS Audit Quality Manager to oversee all HEDIS audit activities across lines of business and regions, ensuring timely submission to NCQA, CMS, and state regulators. The role requires strong collaboration with health plans and internal partners.

The ideal candidate will have extensive HEDIS experience, knowledge of NCQA guidelines, and proven project planning skills to drive complex audits and improvements across multiple teams.

Qualifications

• BA/BS in a health care field or equivalent experience.
• Minimum 3 years healthcare-related experience and 3 years QA/QI-related work.
• Equivalency of education and experience considered.

Responsibilities

• Interfaces with internal/external clients and committees to review HEDIS submissions.
• Manages overall HEDIS audit processes and resources for the team.
• Evaluates NCQA, CMA, and State HEDIS requirements for compliance and reporting.

Skills

HEDIS auditing

QA / QI

Project management

NCQA/HEDIS guidelines

Data analysis

Education

BA/BS in healthcare field

3+ years QA/QI experience

Tools

NCQA guidelines

HEDIS submission processes

Job description

Elevance Health is seeking a HEDIS Audit Quality Manager to oversee all HEDIS audit activities across lines of business and regions, ensuring timely submission to NCQA, CMS, and state regulators. The role requires strong collaboration with health plans and internal partners.

The ideal candidate will have extensive HEDIS experience, knowledge of NCQA guidelines, and proven project planning skills to drive complex audits and improvements across multiple teams.