Senior HEDIS Quality & Audit Analyst

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

📋 Description

• Act as a senior subject matter expert in HEDIS quality oversight, ensuring audit readiness and offering submission support.

• Lead intricate NCQA audit workstreams independently, which includes developing Roadmaps, Section 5 documentation, measure-specific evidence, CAHPS, and managing auditor communications.

• Analyze and apply federal and state regulatory obligations to HEDIS documentation, workflows, and data utilization.

• Offer expert advice on managing reporting populations, selecting measures, and understanding submission requirements.

• Recognize, evaluate, and address audit and submission-related risks.

• Conduct root cause analysis and formulate corrective actions for significant or complex issues.

• Assist with CMS submission tasks, which encompass PLD coordination, testing validation, and ensuring final submission readiness.

• Create, enhance, and uphold enterprise standards, templates, controls, and documentation.

• Serve as an escalation point for intricate audit findings, regulatory interpretation inquiries, and submission decisions.

• Contribute to leadership-level reporting, audit narratives, and governance documentation.

• Propel continuous improvement initiatives to enhance HEDIS audit readiness and submission accuracy.

• Carry out additional duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

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

• A minimum of 4 years of relevant experience in HEDIS, Quality Audits, or regulated healthcare environments is necessary.

• Experience in project management within HEDIS, regulatory, audit, or quality improvement, ideally in a healthcare setting.

• A Master's Degree in Healthcare or a related field is preferred.

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

• Capability to independently interpret regulatory and audit requirements.

• Familiarity with NCQA and CMS expectations.

• Experience in HEDIS quality oversight, audit readiness, and submission support.

• Background in NCQA audit workstreams, including 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.

• Proven experience in identifying and mitigating audit and submission risks.

• Background in root cause analysis and implementing corrective actions.

• Experience in supporting CMS submissions, including PLD coordination, testing validation, and ensuring final submission readiness.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

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

• Additional incentive options may be included in total compensation.

• Accommodation support available.