Senior Auditor, Healthcare

Health Services Advisory Group, Inc. (HSAG)

. Conduct complex healthcare performance measure validation (PMV) activities .

Posted 10/27/2026full-timeRemote • United StatesSenior💰 $100,000 - $130,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in HEDIS Compliance Auditing and healthcare performance measurement, with a strong ability to evaluate information systems and validate performance measures. Proficient in leading audit activities, providing technical guidance, and communicating findings effectively to stakeholders.

Highest-signal resume keywords

HEDIS Compliance AuditingPerformance Measure ValidationHealthcare Information Systems EvaluationSQL, SAS, PythonTechnical Documentation

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Performance Measure ValidationHEDIS Compliance Audit PrinciplesData Integrity EvaluationSource Code ReviewMeasure Calculation MethodologiesPrimary Source VerificationMedical Record Review ValidationData MappingAudit Findings DevelopmentTechnical Guidance

Soft Skills

Analytical SkillsProblem-Solving SkillsInterpersonal CommunicationWritten CommunicationProfessional Judgment

Industry Keywords

CMS EQR Protocol 2NCQA HEDIS Compliance AuditsMedicaid Managed Care ProgramsCMS Core Set SpecificationsHealthcare Performance Measurement Standards

Tech Stack

Tools & technologies

PythonSQL

About the role

Key responsibilities & impact

Conduct complex healthcare performance measure validation (PMV) activities
Apply HEDIS Compliance Audit principles and techniques to HEDIS and non-HEDIS performance measures in accordance with technical specifications, contractual requirements, and CMS EQR Protocol 2
Evaluate information systems, data integrity, measure calculation processes, source code, programming logic, medical record review processes, and reported performance measure results
Lead and conduct HEDIS compliance audits and performance measure validation activities
Conduct information systems assessments and evaluate systems and processes supporting performance measure calculation and reporting
Assess enrollment, claims/encounter, provider, pharmacy, laboratory, medical record, supplemental, vendor, and other data sources
Review source code, programming logic, data mapping, measure workflows, and calculation methodologies
Validate denominator, numerator, exclusions, eligibility, continuous enrollment, clinical coding, sampling, and measure-specific requirements
Conduct primary source verification and record-level testing
Evaluate medical record review processes, abstraction methodologies, sampling, and quality-control procedures
Lead virtual and onsite audit activities and interview client staff
Identify audit findings, assess impact on measure validity, and develop evidence-based conclusions and recommendations
Prepare and review audit workpapers, validation tools, findings, and client-facing reports
Provide senior-level review, technical guidance, and mentoring to auditors and project staff
Communicate technical findings to clients, state Medicaid agencies, internal leadership, and stakeholders
Support continuous improvement of audit methodologies, tools, workpapers, and reporting processes
Maintain current knowledge of HEDIS requirements, CMS EQR protocols, CMS Core Set specifications, and performance measurement standards

Requirements

What you’ll need

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; performance measure validation under CMS EQR Protocol 2; Medicaid and/or CHIP managed care programs; CMS Core Set, state-defined, or other non-HEDIS performance measures; information systems assessments, primary source verification, medical record review validation, and source code review; SQL, SAS, Python, or similar data-query or programming tools
Advanced knowledge of HEDIS performance measurement and audit concepts
Knowledge of CMS EQR performance measure validation requirements and methodologies
Strong understanding of healthcare information systems, data flows, and performance measure calculation processes
Strong analytical, investigative, and problem-solving skills
Ability to interpret technical specifications and translate them into effective audit procedures
Sound professional judgment in evaluating audit evidence and determining the significance of findings
Strong written, verbal, and interpersonal communication skills
Ability to prepare clear, concise, and defensible technical documentation
Ability to manage multiple priorities and meet contractual and regulatory deadlines
Ability to work independently while providing technical leadership and mentoring to other staff