Audit Manager (Healthcare Data)

The Audit Manager primarily supports the HEDIS Audit program by leading the coordination of materials, managing timelines, and providing technical assistance to both internal and external customers. This could extend to other validation programs, as needed. This role ensures adequate staffing to maintain continuous program coverage, including essential operations such as NCQA oversight monitoring and customer policy clarifications. As NCQA identifies new methodologies and requirements for data validation, this position will provide project management support to facilitate seamless and rapid updates to existing programs (e.g., HEDIS Audit, Data Aggregator Validation) and any future data validation product offerings.

Responsibilities

• Support and manage current Audit program activities requiring content knowledge, such as monthly Audit Methodology Panels, Tier 4 Validation protocols, Audit Monitoring and Auditor Update Series.

• Lead routine updates to HEDIS Audit deliverables, such as Volume 5 and Roadmap. This includes derivative productions, such as California AMP program manual and CMS Medicare PLD materials. Ensure deliverables meet quality assurance standards.  

• Provide customer support related to the HEDIS Compliance Audit methodology and other validation tasks. This may require internal collaboration and information sharing.

• Serve as a resource on the HEDIS Compliance Audit and other validation tasks for internal stakeholders. Purposes may include HEDIS measures, product development and state reporting programs.

• Provide project management support through resource coordination and timeline maintenance for efforts focused on inclusion of new standards, policies and procedures in NCQA data validation programs (e.g., HEDIS Audit, DAV).
• Support MDO leadership in representing HEDIS Compliance Audit program and support any validation strategies for program growth.

Requirements

• Bachelor's degree in healthcare-related field (e.g., public health, premed, nursing, health information). Master's degree preferred.
• 3+ years working in health care delivery (e.g., managed care, health system, provider group) or health care related industry (e.g., consulting, health technology, public agency, non-profit) with exposure to healthcare data standards (e.g., FHIR, CCD, X12).
• Proficient in Microsoft applications including Outlook, SharePoint, PowerPoint and Excel.
• Independently produce draft materials such as memos and presentations.
• Comfortable collaborating with individuals of various seniorities and disciplines.
• Capable of project management such as scheduling, development of timelines and document organization.

Compensation & Benefits:

• For new hires, this position pays in the range of $75K - $85K per year, depending on experience.
• This position is eligible for quarterly sales incentive bonus, payable in accordance with policy.
• Click here for employee benefit information.