Senior HEDIS Quality & Audit Analyst

Centene Corporation; Missouri; Teletrabalho; USD 70 000 - 126 000; Tempo integral

Resumo da oferta

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.

Qualificações

• 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.

Responsabilidades

• 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.

Conhecimentos

HEDIS quality oversight

Audit readiness

Regulatory interpretation

Project management

Stakeholder collaboration

Formação académica

Bachelor's degree in healthcare or related field

Master's degree in healthcare or related field

Descrição da oferta de emprego

Position Purpose

The Senior HEDIS Quality & Audit Analyst serves as an enterprise subject matter expert responsible for advanced HEDIS quality oversight, audit readiness, and submission support activities. This role independently interprets regulatory and audit requirements, leads complex HEDIS audit workstreams, and ensures accurate, timely, and audit-defensible documentation and submissions in alignment with NCQA and CMS expectations.

Operating with a high degree of autonomy, the Senior Analyst provides expert guidance on audit risk, regulatory interpretation, and submission requirements while partnering with Health Plans, National and State Auditors, IT, Analytics, and Quality stakeholders.

Key Details

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Applicants for this role have the flexibility to work remotely within the continental United States.

• 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.

Education/Experience

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

Pay Range

Pay Range: $70,100.00 - $126,200.00 per year

About Centene

At Centene, we connect people to the care they need to live healthier lives - and the work you do here makes that impact real every day. You'll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It's work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Benefits

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Equal Opportunity

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Additional Consideration

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act