Remote Senior HEDIS Quality & Audit Analyst

United States Digital Space LLC; United States; Remote; USD 70,000 - 126,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Remote work options

Job summary

Centene is seeking a Senior HEDIS Quality & Audit Analyst to serve as an enterprise SME responsible for advanced HEDIS quality oversight, audit readiness, and submission support across NCQA and CMS expectations.

Operating with autonomy, you will interpret regulatory requirements, lead NCQA audit workstreams, coordinate with health plans, auditors, IT, analytics, and quality stakeholders to ensure audit-defensible documentation and timely submissions.

Qualifications

• Bachelor's degree in Healthcare or related field required.
• 4+ years of experience in HEDIS, quality audits, or regulated healthcare environments.
• Project management experience in HEDIS, regulatory, audit, or quality improvement environments preferred.

Responsibilities

• Serve as a senior SME for HEDIS quality oversight, audit readiness, and submission support.
• Lead complex NCQA audit workstreams, including roadmaps, documentation, and auditor communications.
• Interpret federal and state regulatory requirements to HEDIS documentation and workflows.
• Provide guidance on reporting population applicability, measure selection, and submission needs.
• Identify risks and lead root cause analysis with corrective actions for high-risk issues.
• Support CMS submission activities, including PLD coordination and testing validation.

Skills

HEDIS expertise

Audit management

Regulatory interpretation

Project management

Healthcare compliance

Education

Bachelor's in Healthcare

Master's in Healthcare (preferred)

Job description

Centene is seeking a Senior HEDIS Quality & Audit Analyst to serve as an enterprise SME responsible for advanced HEDIS quality oversight, audit readiness, and submission support across NCQA and CMS expectations.

Operating with autonomy, you will interpret regulatory requirements, lead NCQA audit workstreams, coordinate with health plans, auditors, IT, analytics, and quality stakeholders to ensure audit-defensible documentation and timely submissions.