HEDIS Quality and Audit Analyst

🔥 0 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Support enterprise HEDIS quality oversight, audit readiness, and submission execution activities • Support NCQA audits and CMS submissions by ensuring documentation and deliverables are complete, accurate, and audit-ready • Collaborate with Health Plans and cross-functional partners on HEDIS audit and submission timelines and requirements • Contribute to process improvement through documentation of lessons learned and enhancement opportunities • Perform NCQA HEDIS audit activities, including preparation and maintenance of Roadmaps, Section 5 documentation, CAHPS, and measure-specific evidence • Manage audit and submission timelines, deliverables, and dependencies • Collaborate with Health Plans on reporting population validation and measure selection • Oversee CMS submission activities, including PLD coordination and submission tracking • Apply enterprise standards, templates, and documentation requirements across HEDIS audit deliverables • Identify, document, and escalate audit issues, risks, and documentation gaps • Lead and participate in audit meetings, working sessions, and internal stakeholder reviews • Perform quality checks to ensure audit materials are complete, accurate, and defensible • Comply with all policies and standards and perform other duties as assigned

🎯 Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future • Bachelor's Degree in healthcare or a related field or equivalent experience required • 2+ years of HEDIS, regulatory, audit, or quality improvement experience, preferably in a healthcare environment required • Knowledge of NCQA HEDIS audits and CMS submissions • Ability to prepare and maintain Roadmaps, Section 5 documentation, CAHPS, and measure-specific evidence • Ability to manage audit and submission timelines, deliverables, and dependencies • Experience with reporting population validation and measure selection activities • Ability to coordinate PLD and track CMS submissions • Ability to apply enterprise standards, templates, and documentation requirements • Ability to identify, document, and escalate audit issues, risks, and documentation gaps

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity