HEDIS Audit Quality Lead - Hybrid

Elevance Health; Waukesha (WI); Hybrid; USD 99,000 - 163,000; Full time

Benefits offered by this job

Hybrid work model

Benefits package including 401k

Job summary

Elevance Health is seeking a HEDIS Audit Quality Manager to lead all HEDIS audit activities across lines of business and regulatory bodies. You will oversee audit processes, coordinate with internal teams and health plans to ensure timely submissions to NCQA, CMS, and state regulators.

The role requires a BA/BS in a healthcare field and at least 3 years in healthcare QA/QI, with strong knowledge of NCQA HEDIS guidelines. Hybrid in-office 1-2 days per week; travel not specified.

Qualifications

• BA/BS in a health care field and minimum of 3 years healthcare-related experience, plus 3 years in QA/QI
• Strong knowledge of NCQA HEDIS audit guidelines and processes
• Experience leading HEDIS audits across multiple lines of business and with Medicaid/State Auditors preferred

Responsibilities

• Interfaces with clients, quality committees, and departments for HEDIS submissions
• Manages overall HEDIS audit processes and resources
• Interprets HEDIS guidelines and manages submission activities
• Leads audit project plans with deliverables and timelines
• Performs data analysis and reports improvements to quality committees
• Coordinates with health plans on state audits and reporting requirements

Skills

HEDIS auditing

QA/QI

NCQA guidelines

Project management

Stakeholder management

Education

BA/BS in healthcare

3+ years healthcare QA/QI

Job description

Elevance Health is seeking a HEDIS Audit Quality Manager to lead all HEDIS audit activities across lines of business and regulatory bodies. You will oversee audit processes, coordinate with internal teams and health plans to ensure timely submissions to NCQA, CMS, and state regulators.

The role requires a BA/BS in a healthcare field and at least 3 years in healthcare QA/QI, with strong knowledge of NCQA HEDIS guidelines. Hybrid in-office 1-2 days per week; travel not specified.