高级HEDIS质量与审计分析师
Senior HEDIS Quality & Audit Analyst
职位职责：高级HEDIS质量与审计分析师作为企业级专家，负责高级HEDIS质量监督、审计准备和提交支持活动。该职位独立解读监管和审计要求，领导复杂的HEDIS审计工作流，并确保符合NCQA和CMS期望的准确、及时且可审计的文档和提交。
在高度自主的情况下，高级分析师与健康计划、国家和州审计员、IT、分析和质量相关方合作，提供审计风险、监管解释和提交要求方面的专业指导。
关键信息：必须已获得在美国工作的授权，无需当前或未来任何基于雇佣的签证赞助。此职位不提供任何签证类型的赞助，包括H-1B、L-1、O-1、H-1B1、F-1、J-1、OPT或CPT。
该职位申请人可在美国本土范围内远程工作。
- 作为HEDIS质量监督、审计准备和提交支持活动的高级专家。
- 独立领导复杂的NCQA审计工作流，包括路线图、第5部分文档、特定指标证据、CAHPS和审计员沟通。
- 解释并应用联邦和州监管要求以及适用的州法规，用于HEDIS文档、流程和数据使用。
- 提供关于报告人群适用性/管理、指标选择和提交要求的专业指导。
- 识别、评估和缓解审计和提交风险；对高风险或复杂问题进行根本原因分析并制定纠正措施。
- 支持CMS提交活动，包括PLD协调、测试验证和最终提交准备。
- 开发、优化和维护企业标准、模板、控制和文档，以确保可审计的结果。
- 作为复杂审计发现、监管解释问题和提交决策的升级点。
- 为管理层报告、审计叙述和治理材料做出贡献。
- 推动持续改进计划，加强HEDIS审计准备和提交准确性。
- 执行其他指派的任务。
- 遵守所有政策和标准。
教育/经验：
学士学位
查看英文原文
Position Purpose: The Senior HEDIS Quality & Audit Analyst serves as an enterprise subject matter expert responsible for advanced HEDIS quality oversight, audit readiness, and submission support activities. This role independently interprets regulatory and audit requirements, leads complex HEDIS audit workstreams, and ensures accurate, timely, and audit-defensible documentation and submissions in alignment with NCQA and CMS expectations.
Operating with a high degree of autonomy, the Senior Analyst provides expert guidance on audit risk, regulatory interpretation, and submission requirements while partnering with Health Plans, National and State Auditors, IT, Analytics, and Quality stakeholders.
Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
Applicants for this role have the flexibility to work remotely within the continental United States.
- 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, and applicable state regulations, 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 development of 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 to ensure audit-defensible outcomes.
- 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.
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience:
Bachelor's Degree Healthcare or related field, or equivalent experience required
Master's Degree Healthcare or related field preferred
4+ years Related experience in HEDIS, Quality Audits, or regulated healthcare environments required
Project management experience in HEDIS, regulatory, audit, or quality improvement experience, preferably in a healthcare environment preferred
Pay Range: $70,100.00 - $126,200.00 per year
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Originally posted on Himalayas