Senior Auditor (Healthcare)

Health Services Advisory Group (HSAG); United States; Remote; USD 90.000 - 130.000; Vollzeit

Zusammenfassung

Health Services Advisory Group is seeking a senior auditor to lead HEDIS compliance audits and validate performance measures for diverse clients across the United States.

Responsibilities include reviewing source code, assessment of information systems, validation of denominators/numerators/exclusions, and leading audits both virtually and onsite. The role requires mentoring staff and delivering clear findings to stakeholders.

Qualifikationen

• Bachelor's degree in healthcare, public health, informatics, statistics or related field.
• Significant experience in HEDIS compliance auditing or performance measurement.
• Experience evaluating healthcare information systems and data flows.
• Experience reviewing source code or measure calculation logic.
• Experience conducting audits and communicating results to stakeholders.
• Ability to lead complex audits and mentor other staff.

Aufgaben

• Lead and conduct HEDIS compliance audit and performance measure validation activities
• Review source code, programming logic, and measure calculation methodologies
• Conduct information systems assessments and data integrity reviews
• Validate denominators, numerators, exclusions and measure-specific requirements
• Lead virtual and onsite audits and interviews with client staff
• Prepare audit workpapers, findings and client-facing reports
• Provide senior-level review and technical guidance to auditors

Kenntnisse

Auditing

Healthcare data analysis

Leadership

HEDIS knowledge

Ausbildung

Bachelor's degree

Tools

SQL

SAS

Python

Jobbeschreibung

Responsibilities

• Lead and conduct HEDIS compliance audit and performance measure validation activities
• Review source code, programming logic, and measure calculation methodologies
• Conduct information systems assessments and data integrity reviews
• Validate denominators, numerators, exclusions and measure-specific requirements
• Lead virtual and onsite audits and interviews with client staff
• Prepare audit workpapers, findings and client-facing reports
• Provide senior-level review and technical guidance to auditors

Requirements

• Bachelor's degree in healthcare, public health, informatics, statistics or related field
• Significant experience in HEDIS compliance auditing or performance measurement
• Experience evaluating healthcare information systems and data flows
• Experience reviewing source code or measure calculation logic
• Experience conducting audits and communicating results to stakeholders
• Ability to lead complex audits and mentor other staff

Preferred Qualifications

• NCQA HEDIS Compliance Audit experience
• CMS EQR Protocol 2 performance measure validation experience
• Medicaid and/or CHIP managed care experience
• Familiarity with SQL, SAS, Python or similar tools

About the Company

Health Services Advisory Group is a healthcare quality organization working to improve healthcare delivery across the United States.