Sr. HEDIS Quality & Audit Analyst

Centene
Missouri
Workplace: RemoteFull timeUSD 70,100 - 126,200 annuallyFunction: Quality & Regulatory (Non-Software)Experience: 4+ yearsEducation: bachelorsSkills: ["Autonomy","Risk mitigation","Root cause analysis","Stakeholder partnership","Continuous improvement"]

Serve as an enterprise subject matter expert for HEDIS quality oversight, audit readiness, and submission support. Lead complex NCQA audit workstreams, independently interpret federal and state regulatory requirements, and ensure audit-defensible documentation aligned to NCQA and CMS expectations. Partner with Health Plans, auditors, IT, Analytics, and Quality stakeholders to identify and mitigate audit/submission risks, drive root-cause corrective actions, and support CMS submission readiness, including PLD coordination.

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FursaFursa
Centene
Centene
4 days ago

Sr. HEDIS Quality & Audit Analyst

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Last checked: 3 hours agoStatus: Live

Job Summary

Serve as an enterprise subject matter expert for HEDIS quality oversight, audit readiness, and submission support. Lead complex NCQA audit workstreams, independently interpret federal and state regulatory requirements, and ensure audit-defensible documentation aligned to NCQA and CMS expectations. Partner with Health Plans, auditors, IT, Analytics, and Quality stakeholders to identify and mitigate audit/submission risks, drive root-cause corrective actions, and support CMS submission readiness, including PLD coordination.
Location: Missouri
Workplace: Remote
Employment Type: Full time
Job Function: Quality & Regulatory (Non-Software)
Seniority: Mid level

Key Responsibilities

  • •Independently lead complex NCQA audit workstreams, including Roadmaps and Section 5 documentation, plus measure-specific evidence and auditor communications.
  • •Interpret and apply federal and state regulatory requirements to HEDIS documentation, workflows, and data use.
  • •Identify, assess, and mitigate audit and submission risks; perform root cause analysis and develop corrective actions for high-risk/complex issues.
  • •Support CMS submission activities, including PLD coordination, testing validation, and final submission readiness.
  • •Develop and maintain enterprise standards, templates, controls, and documentation to ensure audit-defensible outcomes; act as an escalation point for complex audit findings and interpretation questions.

Pay and Benefits

Salary: USD 70,100 - 126,200 annually
Equity and Bonus:Equity
Perks:Health Insurance401kPaid Leave

Key Requirements

  • •Bachelor's degree in Healthcare or related field, or equivalent experience required.
  • •4+ years of 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.
  • •Master's degree in Healthcare or related field preferred.
  • •Ability to independently interpret regulatory and audit requirements and support audit-defensible HEDIS documentation and submissions.
Experience:4+ yearsHealthcareHEDISQuality auditsRegulated healthcare
Education:Bachelor's in Healthcare or related field
Skills:AutonomyRisk mitigationRoot cause analysisStakeholder partnershipContinuous improvement
Tech Stack:NCQACMSCAHPS

Eligibility

Work Authorization:Authorization required. Sponsorship not provided.

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn