HEDIS Quality and Audit Analyst
Required skills
- HEDIS
- NCQA
- CMS
- audit
- quality improvement
- regulatory
- healthcare
Nice to have
- CAHPS
- PLD coordination
Role summary
The HEDIS Quality and Audit Analyst supports enterprise HEDIS quality oversight, audit readiness, and submission execution. This role ensures documentation and deliverables meet NCQA and CMS standards for audits and submissions. The Analyst collaborates with Health Plans and cross-functional partners to manage timelines, validate reporting populations, and oversee CMS submissions. Key responsibilities include performing quality checks, identifying and escalating risks, and maintaining audit documentation. A Bachelor's degree in healthcare or a related field, or equivalent experience, and 2+ years of HEDIS, regulatory, audit, or quality improvement experience are required.
The HEDIS Quality & Audit Analyst supports enterprise HEDIS quality oversight, audit readiness, and submission execution activities. This role applies established standards, processes, and regulatory requirements to support NCQA audits and CMS submissions, ensuring documentation and deliverables are complete, accurate, and audit-ready.
The Analyst works collaboratively with Health Plans and cross-functional partners to support HEDIS audit and submission timelines and requirements.
- Provide support for HEDIS quality oversight, audit readiness, and submission support activities.
- Contribute to process improvement efforts through documentation of lessons learned and enhancement opportunities.
- Perform NCQA HEDIS audit activities, including preparation and maintenance of Roadmaps, Section 5 documentation, CAHPS and measure-specific evidence.
- Manage audit and submission timelines, deliverables, and dependencies.
- Collaborate with Health Plans on reporting population validation and measure selection activities.
- Oversee CMS submission activities, including PLD coordination and submission tracking.
- Apply enterprise standards, templates, and documentation requirements across HEDIS audit deliverables.
- Identify, document, and escalate audit issues, risks, and documentation gaps.
- Lead and actively participate in audit meetings, working sessions, and internal stakeholder reviews.
- Perform quality checks to ensure audit materials are complete, accurate, and defensible.
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience:
Bachelor's Degree healthcare or a related field or equivalent experience required required
2+ years years of HEDIS, regulatory, audit, or quality improvement experience, preferably in a healthcare environment required
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
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.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
