Remote Senior HEDIS Quality & Audit Lead

Centene Corporation; Missouri; À distance; USD 70 000 - 126 000; Plein temps

Résumé du poste

Centene is seeking a Senior HEDIS Quality & Audit Analyst to oversee HEDIS quality, audit readiness, and CMS submission support. This role provides expert guidance on regulatory interpretation and audit risk, partnering with plans, auditors, IT, and quality stakeholders.

The successful candidate will lead NCQA audit workstreams, ensure audit-defensible documentation, and drive continuous improvement in submission accuracy while maintaining enterprise standards and governance.

Qualifications

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

Responsabilités

• Serve as senior SME for HEDIS quality oversight, audit readiness and submission support.
• Lead complex NCQA audit workstreams including roadmaps, Section 5 documentation and CAHPS communications.
• Interpret and apply federal and state regulatory requirements to HEDIS documentation and workflows.
• Provide guidance on reporting population applicability, measure selection and submission requirements.
• Identify, assess and mitigate audit and submission risks; lead root cause analysis and corrective actions.
• Support CMS submission activities including PLD coordination and testing validation.
• Develop and maintain enterprise standards, templates, controls and documentation for audit-defensible outcomes.
• Escalate complex audit findings and contribute to governance materials.
• Drive continuous improvement to strengthen audit readiness and submission accuracy.

Connaissances

HEDIS quality oversight

Audit readiness

Regulatory interpretation

Project management

Stakeholder collaboration

Formation

Bachelor's degree in healthcare or related field

Master's degree in healthcare or related field

Description du poste

Centene is seeking a Senior HEDIS Quality & Audit Analyst to oversee HEDIS quality, audit readiness, and CMS submission support. This role provides expert guidance on regulatory interpretation and audit risk, partnering with plans, auditors, IT, and quality stakeholders.

The successful candidate will lead NCQA audit workstreams, ensure audit-defensible documentation, and drive continuous improvement in submission accuracy while maintaining enterprise standards and governance.