Remote Senior HEDIS Quality & Audit Lead

Centene Corporation; United States; Remote; USD 70,000 - 126,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Remote, hybrid, field or office work

Job summary

Centene Corporation seeks a Senior HEDIS Quality & Audit Analyst to serve as an enterprise subject matter expert responsible for advanced HEDIS quality oversight, audit readiness, and submission support aligned with NCQA and CMS expectations.

Operating with high autonomy, this role guides audit risk, regulatory interpretation, and submission requirements while partnering with Health Plans, National and State Auditors, IT, Analytics, and Quality stakeholders.

Qualifications

• Bachelor's Degree in Healthcare or related field, or equivalent experience.
• 4+ years related experience in HEDIS, Quality Audits, or regulated healthcare environments.
• Project management experience in HEDIS, regulatory, audit, or quality improvement experience, preferably in a healthcare environment

Responsibilities

• Serve as a senior subject matter expert for HEDIS quality oversight, audit readiness, and submission support activities.
• Independently lead complex NCQA audit workstreams, including Roadmaps, Section 5 documentation, measure-specific evidence, CAHPS and auditor communications.
• Interpret and apply federal and state regulatory requirements, and applicable state regulations, to HEDIS documentation, workflows, and data use.
• Provide expert guidance on reporting population applicability/management, measure selection, and submission requirements.
• Identify, assess, and mitigate audit and submission risks; lead root cause analysis and development of corrective actions for high-risk or complex issues.
• Support CMS submission activities, including PLD coordination, testing validation, and final submission readiness.
• Develop, refine, and maintain enterprise standards, templates, controls, and documentation to ensure audit-defensible outcomes.
• Act as an escalation point for complex audit findings, regulatory interpretation questions, and submission decisions.
• Contribute to leadership-level reporting, audit narratives, and governance materials.
• Drive continuous improvement initiatives to strengthen HEDIS audit readiness and submission accuracy.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

HEDIS quality oversight

audit readiness

regulatory interpretation

project management

data interpretation

Education

Bachelor's Degree in Healthcare or related field

Master's Degree in Healthcare or related field (preferred)

Job description

Centene Corporation seeks a Senior HEDIS Quality & Audit Analyst to serve as an enterprise subject matter expert responsible for advanced HEDIS quality oversight, audit readiness, and submission support aligned with NCQA and CMS expectations.

Operating with high autonomy, this role guides audit risk, regulatory interpretation, and submission requirements while partnering with Health Plans, National and State Auditors, IT, Analytics, and Quality stakeholders.