HEDIS Audit Quality Manager (State and NCQA)

Elevance Health•Cincinnati, OH

4d•$99,372 - $163,254•Hybrid

About The Position

The HEDIS Audit Quality Manager is responsible for managing all HEDIS Audit activities for all lines of business, region of the company, market, and/or enterprise wide which are necessary for submission of audited HEDIS and CAHPS results to NCQA, CMS, and State Regulatory Agencies. This role interfaces with internal and external clients, quality committees, and departments in the review of HEDIS submissions and requirements. The manager evaluates, interprets and summarizes HEDIS audit guidelines and manages the process for HEDIS submission activities. They identify appropriate resources and accountabilities for project teams involved with the HEDIS audit and conduct ongoing evaluation and interpretation of NCQA, CMA, and State HEDIS requirements to ensure compliance through reporting and measurement studies/ methodologies. This role serves as an expert resource to quality committees and business owners across the organization, leading and providing oversight of quality studies/projects. The manager facilitates project management and develops comprehensive HEDIS audit work plans by establishing deliverables, accountabilities, and timelines. They perform quantitative and qualitative analysis of quality related data and reports activities, improvements, and recommendations to the quality committee. Additionally, they coordinate with health plans on state specific audits and reporting requirements.

Requirements

BA/BS in a health care field and minimum of 3 years healthcare-related experience
Minimum of 3 years’ experience in a QA/QI related position
Any combination of education and experience, which would provide an equivalent background.

Nice To Haves

Extensive experience managing the overall HEDIS audit processes for all lines of business with Medicaid State Auditors and/or National Auditors strongly preferred.
Strong knowledge of the NCQA HEDIS audit guidelines and processes used to submit HEDIS to the National and State HEDIS auditors strongly preferred.
Experience creating and managing a large project plan that identifies appropriate resources and accountabilities for project teams involved with the HEDIS audit.
Experience leading mock interviews with internal departments to prepare for the external HEDIS Audits.
HEDIS audit experience preferred.
Experience with Medicaid preferred.

Responsibilities

Manages the overall HEDIS audit processes and resources required to successfully lead the team.
Evaluates, interprets and summarizes HEDIS audit guidelines and manages the process for HEDIS submission activities.
Identifies appropriate resources and accountabilities for project teams involved with the HEDIS audit.
Conducts the ongoing evaluation and interpretation of NCQA, CMA, and State HEDIS requirements to ensure compliance through reporting and measurement studies/ methodologies.
Serves as expert resource to quality committees and business owners across the organization.
Leads and provides oversight of quality studies/projects.
Facilitates project management and develops comprehensive HEDIS audit work plans by establishing deliverables, accountabilities, and timelines.
Performs quantitative and qualitative analysis of quality related data and reports activities, improvements, and recommendations to the quality committee.
Coordinates with health plans on state specific audits and reporting requirements.