*Applicants for this job have the flexibility to work remote from home anywhere in the United States.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.
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.
- 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
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.
