Senior HEDIS & Health Data Auditor

Health Services Advisory Group, Inc.; Phoenix (AZ); On-site; USD 100,000 - 130,000; Full time

Job summary

Health Services Advisory Group is seeking a Senior Auditor to perform complex healthcare PMV and HEDIS validation in the United States. You will evaluate data integrity, source code, and reporting processes while mentoring staff and leading audits to ensure accuracy and adherence to CMS specifications.

The role requires extensive experience in HEDIS compliance auditing, advanced knowledge of data sources, programming, and validation methodologies, with opportunities to guide client engagements

Qualifications

• Bachelor's degree in healthcare administration, public health, health information management, nursing, information systems, statistics, data analytics, or a related field.
• Significant experience in HEDIS compliance auditing, healthcare performance measurement, performance measure validation, healthcare data validation, or a related field.
• Demonstrated ability to interpret and apply complex performance measure specifications.
• Experience evaluating healthcare information systems, data flows, and data used for performance measure reporting.
• Experience reviewing source code, programming logic, or measure calculation methodologies, directly or in collaboration with technical staff.
• Experience conducting audits, developing findings, documenting supporting evidence, and communicating results to clients and stakeholders.
• Demonstrated ability to lead complex audit activities and provide technical guidance to other staff.

Responsibilities

• Lead and conduct HEDIS compliance audit and performance measure validation activities.
• Apply HEDIS audit techniques and methodologies to HEDIS, CMS Core Set, state-defined, HRSA, AHRQ, and other performance measures.
• Conduct information systems assessments and evaluate systems supporting measure calculation and reporting.
• Assess data sources: enrollment, claims, provider, pharmacy, lab, medical records, and vendor data.
• Review source code, logic, data mapping, and measure workflows for compliance.
• Validate denominator, numerator, exclusions, eligibility, continuous enrollment, coding, sampling.
• Conduct primary source verification and record-level testing to verify data accuracy.
• Evaluate medical record review processes and sampling quality-control procedures.
• Lead audit activities and conduct interviews with client staff responsible for IS, data management, or reporting.
• Identify findings and develop evidence-based conclusions and recommendations.
• Prepare audit workpapers, findings, and client-facing reports.

Skills

Analytical thinking

Investigation

Problem solving

Communication

Leadership

Education

Bachelor's degree in healthcare administration / public health / health information management / nursing / information systems / statistics / data analytics

Tools

SQL

SAS

Python

Job description

Health Services Advisory Group is seeking a Senior Auditor to perform complex healthcare PMV and HEDIS validation in the United States. You will evaluate data integrity, source code, and reporting processes while mentoring staff and leading audits to ensure accuracy and adherence to CMS specifications.

The role requires extensive experience in HEDIS compliance auditing, advanced knowledge of data sources, programming, and validation methodologies, with opportunities to guide client engagements