HEDIS Quality and Audit Analyst

Centene Corporation; Missouri; Hybride; USD 70 000 - 95 000; Plein temps

Avantages offerts par ce poste

Health insurance

401K plan

Stock purchase plans

Tuition reimbursement

Paid time off + holidays

Résumé du poste

Centene Corporation seeks an HEDIS Quality & Audit Analyst to support enterprise HEDIS quality oversight, audit readiness, and CMS submissions. You will collaborate with Health Plans and cross-functional teams to ensure audit-ready documentation and timely deliverables.

Required bachelor's degree in healthcare or related field and 2+ years in HEDIS, regulatory, audit, or quality improvement. The role offers flexible remote work within the continental U.S. and a comprehensive benefits package.

Qualifications

• 2+ years of HEDIS, regulatory, audit, or quality improvement experience
• Experience supporting NCQA audits and CMS submissions
• Ability to document lessons learned and drive enhancements

Responsabilités

• Provide support for HEDIS quality oversight, audit readiness, and submission activities.
• Contribute to process improvements through documentation of lessons learned and enhancement opportunities.
• Perform NCQA HEDIS audit activities, including Roadmaps, Section 5 documentation, and CMS evidence.
• Manage audit and submission timelines, deliverables, and dependencies.
• Collaborate with Health Plans on reporting population validation and measure selection.
• Oversee CMS submission activities, including PLD coordination and submission tracking.
• Apply enterprise standards to HEDIS audit deliverables and identify gaps.

Connaissances

HEDIS experience

Regulatory knowledge

Audit experience

Quality improvement

Formation

Bachelor's Degree in healthcare or related field

Description du poste

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.

Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Applicants for this role have the flexibility to work remotely within the continental United States.

• 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 escalation 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 required

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 offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and 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.

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