HEDIS Quality and Audit Analyst

This is a fully remote position, open to applicants in Missouri.

📋 Description

• Provide support for enterprise HEDIS quality oversight, audit readiness, and the execution of submission activities.

• Assist with NCQA audits and CMS submissions by ensuring all documentation and deliverables are complete, accurate, and ready for audit.

• Collaborate with Health Plans and cross-functional partners regarding HEDIS audit and submission timelines and requirements.

• Contribute to process enhancements by documenting lessons learned and identifying opportunities for improvement.

• Execute NCQA HEDIS audit tasks, including the preparation and upkeep of Roadmaps, Section 5 documentation, CAHPS, and measure-specific evidence.

• Manage timelines, deliverables, and dependencies related to audits and submissions.

• Work with Health Plans on validating reporting populations and selecting measures.

• Supervise CMS submission activities, including PLD coordination and tracking submissions.

• Implement enterprise standards, templates, and documentation requirements across HEDIS audit deliverables.

• Identify, document, and escalate any audit issues, risks, and documentation deficiencies.

• Lead and participate in audit meetings, working sessions, and reviews with internal stakeholders.

• Conduct quality checks to ensure that audit materials are thorough, accurate, and defensible.

• Adhere to all policies and standards while performing additional duties as assigned.

⛳️ Requirements

• Must have authorization to work in the U.S. without the need for employment-based visa sponsorship, either now or in the future.

• A Bachelor's Degree in healthcare or a related field, or equivalent experience is required.

• A minimum of 2 years of experience in HEDIS, regulatory, audit, or quality improvement, preferably in a healthcare setting, is required.

• Familiarity with NCQA HEDIS audits and CMS submissions is essential.

• Capability to prepare and maintain Roadmaps, Section 5 documentation, CAHPS, and measure-specific evidence.

• Skilled in managing audit and submission timelines, deliverables, and dependencies.

• Experience in validating reporting populations and selecting measures.

• Ability to coordinate PLD and track CMS submissions effectively.

• Proficiency in applying enterprise standards, templates, and documentation requirements.

• Competence in identifying, documenting, and escalating audit issues, risks, and documentation gaps.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Additional forms of incentives may be included in total compensation.

• Equal opportunity employer committed to diversity.