Senior HEDIS Quality – Audit Analyst

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

📋 Description

• Act as a senior subject matter expert overseeing HEDIS quality, ensuring audit readiness, and providing support for submission activities.

• Take the lead on intricate NCQA audit workstreams, which include developing Roadmaps, preparing Section 5 documentation, gathering measure-specific evidence, and managing CAHPS and auditor communications.

• Analyze and apply federal and state regulatory standards, along with relevant state regulations, to HEDIS documentation, workflows, and data utilization.

• Offer expert advice on the applicability and management of reporting populations, selection of measures, and requirements for submissions.

• Identify, evaluate, and mitigate risks related to audits and submissions; spearhead root cause analyses and formulate corrective actions for high-risk or complex issues.

• Assist with CMS submission processes, which encompass PLD coordination, testing validation, and readiness for final submissions.

• Create, enhance, and uphold enterprise standards, templates, controls, and documentation to guarantee audit-ready outcomes.

• Serve as a point of escalation for intricate audit findings, questions regarding regulatory interpretations, and decisions related to submissions.

• Contribute to reports for leadership, audit narratives, and governance documents.

• Lead initiatives for continuous improvement aimed at enhancing HEDIS audit readiness and accuracy in submissions.

• Perform additional duties as assigned.

⛳️ Requirements

• Required: Bachelor's Degree in Healthcare or a related field, or equivalent experience.

• Preferred: Bachelor's Degree in Healthcare or a related field.

• At least 4 years of relevant experience in HEDIS, quality audits, or regulated healthcare environments is required.

• Project management experience in HEDIS, regulatory, audit, or quality improvement is preferred.

• Experience with LTSS is highly preferred.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K and stock purchase plans.

• Tuition reimbursement.

• Paid time off in addition to holidays.

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