HEDIS Quality and Audit Analyst

Centene Management Company LLC; Missouri; Hybrid; USD 65,000 - 85,000; Full time

Benefits offered by this job

Health insurance

401K and stock plans

Tuition reimbursement

Paid time off

Flexible work arrangements

Remote/Hybrid options

Job summary

Centene Management Company LLC seeks an HEDIS Quality & Audit Analyst to support enterprise HEDIS quality oversight, audit readiness, and submission execution. You will apply standards and regulatory requirements to ensure documentation is complete and audit-ready.

The role collaborates with Health Plans and cross-functional partners to meet audit timelines, prepare Roadmaps, CAHPS evidence, and manage CMS submissions.

Qualifications

• Bachelor's Degree healthcare or a related field.
• 2+ years of HEDIS, regulatory, audit, or quality improvement experience, preferably in a healthcare environment.

Responsibilities

• Support HEDIS audit readiness, submission activities, and documentation.
• Maintain audit roadmaps, Section 5 documentation, CAHPS and measure-specific evidence.
• Collaborate with Health Plans and cross-functional partners to meet audit timelines and requirements.
• Identify, document, and elevate audit issues, risks, and gaps; participate in review meetings.

Skills

HEDIS knowledge

Audit experience

Regulatory knowledge

Quality improvement

CAHPS knowledge

Education

Bachelor's degree in healthcare or related field

Job description

Position Purpose

The HEDIS Quality & Audit Analyst supports enterprise HEDIS quality oversight, audit readiness, and submission execution activities. This role applies established standards, processes, and regulatory requirements to support NCQA audits and CMS submissions, ensuring documentation and deliverables are complete, accurate, and audit-ready. The Analyst works collaboratively with Health Plans and cross-functional partners to support HEDIS audit and submission timelines and requirements. Provide support for HEDIS quality oversight, audit readiness, and submission support activities. Contribute to process improvement efforts through documentation of lessons learned and enhancement opportunities. Perform NCQA HEDIS audit activities, including preparation and maintenance of Roadmaps, Section 5 documentation, CAHPS and measure-specific evidence. Manage audit and submission timelines, deliverables, and dependencies. Collaborate with Health Plans on reporting population validation and measure selection activities. Oversee CMS submission activities, including PLD coordination and submission tracking. Apply enterprise standards, templates, and documentation requirements across HEDIS audit deliverables. Identify, document, and elevate audit issues, risks, and documentation gaps. Lead and actively participate in audit meetings, working sessions, and internal stakeholder reviews. Perform quality checks to ensure audit materials are complete, accurate, and defensible. Performs other duties as assigned. Complies with all policies and standards.

Education & Experience

Bachelor's Degree healthcare or a related field or equivalent experience required. 2+ years of HEDIS, regulatory, audit, or quality improvement experience, preferably in a healthcare environment.

Benefits & Compensation

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules
• Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.
• Total compensation may also include additional forms of incentives.
• Benefits may be subject to program eligibility.

EEO & Diversity Statement

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.

Company Culture & Mission

At Centene, we connect people to the care they need to live healthier lives - and the work you do here makes that impact real every day. You'll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It's work with a purpose you can see, backed by a team committed to improving lives well beyond the workday. Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.