Senior HEDIS Quality & Audit Analyst
About The Position
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.
Requirements
- Bachelor's Degree Healthcare or related field, or equivalent experience required.
- 4+ years Related experience in HEDIS, Quality Audits, or regulated healthcare environments required.
Nice To Haves
- 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.
- LTSS experience highly preferred.
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.
Benefits
- competitive pay
- health insurance
- 401K
- 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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What This Job Offers
Job Type
Full-time
Career Level
Senior
