The SDS Consultant is responsible for ensuring the accuracy, completeness, and audit-readiness of Supplemental Data Source (SDS) documentation, with a primary focus on HEDIS Section 5 compliance. This role plays a critical part in supporting successful audit outcomes by reviewing, editing, and validating documentation, as well as coordinating remediation efforts and verification activities.
Work Location- Telecommute (home-based)
- Must have reliable, hardwired high-speed internet (Wi-Fi not permitted)
Work Hours- Standard day shift: 9:00 AM - 5:00 PM (EST or CST)
Team Environment- Small, highly collaborative team of 4 professionals
- Focus on quality, compliance, and audit readiness
- Team culture emphasizes:
- Accountability and responsiveness
- Strong attention to detail
- Continuous feedback and improvement
If you are able to work EST/CST schedule, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:- Section 5 Documentation Review & Optimization
- Conduct comprehensive reviews of Section 5 submissions for completeness, accuracy, and compliance with NCQA standards
- Provide actionable feedback and detailed editing recommendations to improve documentation quality
- Audit Readiness & Compliance Support
- Ensure all supplemental data sources meet audit standards and are properly documented
- Identify risks, gaps, or inconsistencies and recommend corrective actions
- Stakeholder Communication & Follow-Up
- Collaborate with internal teams to communicate required updates and track progress
- Proactively follow up to confirm implementation of recommended changes
- Primary Source Verification (PSV)
- Perform PSV activities, including chart reviews, for non-standard supplemental data sources
- Validate data integrity and ensure adherence to audit requirements
- Data Tracking & Tool Management
- Accurately enter and maintain data within the SDS tracking tool
- Track Section 5 progress, PSV results, and auditor issue logs
- Ensure timely resolution and proper documentation of all audit findings
- Issue Identification & Resolution
- Monitor and manage auditor feedback and issue logs
- Support root cause analysis and corrective action tracking
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:- 2+ years of HEDIS audit experience
- Experience with Section 5 documentation
- Experience with Supplemental Data Sources (SDS)
- Able to work EST or CST schedule
Preferred Qualification:- Experience supporting NCQA audits
Core Competencies- Exceptional attention to detail - ability to identify subtle discrepancies and ensure accuracy in documentation
- Strong written and verbal communication skills - clear, concise, and professional communication with stakeholders
- Responsiveness and accountability - ability to manage deadlines and follow through consistently
- Analytical thinking - ability to interpret audit requirements and apply them effectively
- Adaptability and quick learning - ability to rapidly understand tools, processes, and evolving audit requirements
- Technical Skills
- Experience working with audit tracking tools or data systems
- Proficiency in data entry, tracking, and documentation management
- Familiarity with healthcare data, coding, and chart review processes preferred
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.
