Senior Auditor (Healthcare)

Remotefull timeRemote

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senior

$100k–$130k

H1B: no

Hsag The Senior Auditor at HSAG conducts complex healthcare performance measure validation activities applying HEDIS Compliance Audit principles. This role involves evaluating data integrity, measure calculation processes, and providing technical leadership.

Responsibilities

Lead and conduct HEDIS compliance audit and performance measure validation activities
Apply HEDIS audit techniques to various performance measures
Conduct information systems assessments and evaluate supporting processes
Assess accuracy and integration of multiple data sources
Review source code, programming logic, and calculation methodologies
Validate measure-specific requirements including denominator and numerator
Conduct primary source verification and record-level testing
Evaluate medical record review processes and quality-control procedures
Lead virtual and onsite audit activities and conduct interviews
Identify audit findings and develop evidence-based conclusions and recommendations
Prepare and review audit workpapers, validation tools, findings, and reports
Provide senior-level review and technical guidance to auditors and project staff

Qualification

Experience reviewing source codeExperience conducting auditsExperience validating CMS Core SetFamiliarity with SQLKnowledge

Required

Bachelor's degree in healthcare administration, public health, health information management, nursing, information systems, statistics, data analytics, or a related field.
Significant experience in HEDIS compliance auditing, healthcare performance measurement, performance measure validation, healthcare data validation, or a related field.
Demonstrated ability to interpret and apply complex performance measure specifications.
Experience evaluating healthcare information systems, data flows, and data used for performance measure reporting.
Experience reviewing source code, programming logic, or measure calculation methodologies, directly or in collaboration with technical staff.
Experience conducting audits, developing findings, documenting supporting evidence, and communicating results to clients and stakeholders.
Demonstrated ability to lead complex audit activities and provide technical guidance to other staff.

Preferred

Experience conducting NCQA HEDIS Compliance Audits.
Experience conducting performance measure validation under CMS EQR Protocol 2.
Experience with Medicaid and/or CHIP managed care programs.
Experience validating CMS Core Set, state-defined, or other non-HEDIS performance measures.
Experience with information systems assessments, primary source verification, medical record review validation, and source code review.
Familiarity with SQL, SAS, Python, or similar data-query or programming tools.
Knowledge, Skills, and Abilities
Advanced knowledge of HEDIS performance measurement and audit concepts.

Company

Hsag

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Source: lever

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Remote-friendly

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