HEDIS Audit Quality Lead (State/NCQA)

Elevance Health; Atlanta (GA); Hybrid; USD 99,000 - 163,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase plan

Incentive and recognition programs

401k contribution

Job summary

Elevance Health is seeking a HEDIS Audit Quality Manager to oversee all HEDIS audit activities across lines of business and regions. This role supports submission to NCQA, CMS, and state regulators, interfacing with clients and internal teams.

The ideal candidate will manage audit processes, interpret guidelines, and coordinate resources for timely deliverables while working in a hybrid in-office/remote setup.

Qualifications

• Requires a BA/BS in a health care field and minimum 3 years healthcare-related experience, plus at least 3 years in a QA/QI role or equivalent.
• Extensive experience managing HEDIS audit processes for Medicaid and National Auditors is preferred.
• Strong knowledge of NCQA HEDIS guidelines and submission processes.
• Experience leading large project plans with defined resources and accountabilities.

Responsibilities

• Interface with clients and departments to review HEDIS submissions and requirements.
• Lead overall HEDIS audit processes and allocate resources for the team.
• Interpret HEDIS guidelines and oversee submission activities.
• Determine resources and accountability for audit project teams.
• Monitor NCQA, CMA, and State HEDIS requirements and ensure compliance.
• Provide expert guidance to quality committees and business owners.
• Lead and oversee quality studies and audits; develop detailed work plans.
• Perform data analysis and report improvements to the quality committee.
• Coordinate with health plans on state-specific audits and reporting.

Skills

Quality audit management

NCQA HEDIS guidelines

Project planning

Internal stakeholder management

Education

BA/BS in health care field

Healthcare QA/QI experience 3+ years

Job description

Elevance Health is seeking a HEDIS Audit Quality Manager to oversee all HEDIS audit activities across lines of business and regions. This role supports submission to NCQA, CMS, and state regulators, interfacing with clients and internal teams.

The ideal candidate will manage audit processes, interpret guidelines, and coordinate resources for timely deliverables while working in a hybrid in-office/remote setup.