HEDIS Compliance Audit Specialist / Manager (JR140903)

Location: Alternate locations in addition to the posted locations may be considered. This position will work in a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

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. Primary duties may include, but are not limited to:

Interfaces with internal and external clients, quality committees, and departments in the review of HEDIS submissions and requirements.

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.

Minimum Requirements:

Requires a BA/BS in a health care field and minimum of 3 years healthcare-related experience, in addition, minimum of 3 years’ experience in a QA/QI related position; or any combination of education and experience, which would provide an equivalent background.Preferred Qualifications:

Extensive experience managing the overall HEDIS audit processes for all lines of business with both National and Medicaid State Auditors.

Strong knowledge of the NCQA HEDIS audit guidelines and processes used to submit HEDIS to the National and State HEDIS auditors.

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.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.