Note: The job is a remote job and is open to candidates in USA. Centene Corporation is a healthcare organization focused on improving access to care and health outcomes. The Senior HEDIS Quality & Audit Analyst provides expert oversight of HEDIS quality activities, leads complex NCQA audit workstreams, interprets regulatory requirements, supports CMS submissions, and drives audit readiness and continuous improvement.
Responsibilities
- 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
Skills
- Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
- Applicants for this role have the flexibility to work remotely within the continental United States
- Bachelor's Degree Healthcare or related field, or equivalent experience required
- 4+ years Related experience in HEDIS, Quality Audits, or regulated healthcare environments required
- Master's Degree Healthcare or related field preferred
- Project management experience in HEDIS, regulatory, audit, or quality improvement experience, preferably in a healthcare environment preferred
Benefits
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- A flexible approach to work with remote, hybrid, field or office work schedules
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