Senior HEDIS Quality & Audit Analyst

Role Overview

• 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.

Requirements

• Bachelor's Degree Healthcare or related field, or equivalent experience required
• Master's Degree Healthcare or related field preferred
• 4+ years 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 preferred
• LTSS experience highly preferred

Benefits

• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field, or office schedules