Senior HEDIS Quality & Audit Analyst

🔥 0 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $70.1k - $126.2k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

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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

• 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 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 develop 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 • 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 • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Bachelor's Degree in Healthcare or related field, or equivalent experience required • 4+ years of related experience in HEDIS, Quality Audits, or regulated healthcare environments required • Project management experience in HEDIS, regulatory, audit, or quality improvement, preferably in a healthcare environment • Master's Degree in Healthcare or related field preferred • Must be authorized to work in the U.S. without employment-based visa sponsorship now or in the future • Ability to independently interpret regulatory and audit requirements • Knowledge of NCQA and CMS expectations • Experience with HEDIS quality oversight, audit readiness, and submission support • Experience with NCQA audit workstreams, Roadmaps, Section 5 documentation, measure-specific evidence, CAHPS, and auditor communications • Knowledge of federal and state regulatory requirements and state regulations • Experience with reporting population applicability/management, measure selection, and submission requirements • Experience identifying and mitigating audit and submission risks • Experience with root cause analysis and corrective actions • Experience supporting CMS submissions, PLD coordination, testing validation, and final submission readiness

🏖️ Benefits

• competitive pay • health insurance • 401K • 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 • Accommodation support available