HEDIS Lead

Job Description

Job Description

Description:

Verda Healthcare, Inc. is a Medicare Advantage Prescriptions Drug Plan (MAPD) organization committed to the idea that healthcare should be easily and equitably accessed by all, currently available in Texas and Arizona. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for a HEDIS Lead to join our growing company with many internal opportunities.

Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare, Inc. is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.

Align your career goals with Verda Healthcare, Inc. and we will support you all the way.

Position Overview

The HEDIS Compliance and Project Lead is responsible for leading the planning, coordination, execution, and audit readiness activities supporting the organization's annual HEDIS reporting program. This position reports to the Senior Manager, HEDIS & Quality Improvement and serves as a key liaison between Quality Improvement, Analytics, Operations, Provider Network, Compliance, delegated entities, and external vendors.

The ideal candidate possesses demonstrated experience supporting NCQA HEDIS Compliance Audits , audit documentation management, universe validation, data integrity review, and cross-functional project management. Success in this role requires exceptional organizational skills, the ability to manage multiple concurrent workstreams, and experience driving accountability across internal teams and external stakeholders.

This position plays a critical role in maintaining year-round audit readiness, coordinating project plans and deliverables, and ensuring accurate, timely, and compliant HEDIS submissions. Candidates with direct NCQA audit experience, including auditor-facing responsibilities and universe validation activities, are strongly preferred.

Future Leadership Opportunity

This role is intended for a motivated professional who is seeking to grow beyond HEDIS operations and into broader program leadership. In addition to managing key HEDIS, audit, and quality initiatives, the successful candidate will have opportunities to develop competencies in strategic planning, stakeholder management, operational leadership, and regulatory oversight.

As the organization continues to grow, this position is expected to serve as a pipeline for future leadership opportunities, including potential advancement into a Senior Manager-level role for candidates who consistently demonstrate exceptional performance, leadership, and business acumen.

Essential Responsibilities

HEDIS Program Planning & Management

• Lead the development, coordination, and execution of annual HEDIS project plans, timelines, milestones, and deliverables.
• Coordinate cross-functional activities across Quality, Analytics, Operations, Provider Network, Compliance, delegated entities, and vendor partners.
• Monitor progress toward project objectives and identify risks, barriers, and dependencies that may impact reporting timelines.
• Facilitate project status meetings and maintain action plans to ensure timely completion of deliverables.
• Collaborate with stakeholders to implement strategies that improve HEDIS performance and operational effectiveness.
• Support strategic quality initiatives that align with organizational goals and CMS Star Ratings performance.
• Track and report progress of HEDIS-related initiatives to leadership.

HEDIS Audit & Compliance Leadership

• Serve as a primary coordinator for annual NCQA HEDIS Compliance Audit activities.
• Lead year-round audit readiness efforts, including documentation management, process reviews, evidence collection, and audit preparation.
• Coordinate and support universe validation activities to ensure accuracy, completeness, and compliance with NCQA audit requirements.
• Manage audit request logs, documentation repositories, timelines, and evidence submissions.
• Facilitate communication between auditors, vendors, technical teams, and operational stakeholders.
• Partner with Analytics and IT teams to investigate and resolve data integrity issues, audit findings, and validation discrepancies.
• Review and validate supporting documentation, data sources, and audit artifacts to ensure compliance with regulatory requirements.
• Participate in corrective action planning and implementation resulting from audit findings or process improvement opportunities.
• Maintain audit documentation and reporting processes that support organizational compliance objectives.

Data Quality Management (DQM)

• Support Data Quality Management project planning, execution, tracking, and reporting.
• Perform and coordinate data validation activities related to HEDIS and quality reporting programs.
• Collaborate with operational and technical teams to identify, analyze, and resolve data quality concerns.
• Conduct root cause analyses and support implementation of corrective actions.
• Monitor ongoing data quality initiatives and recommend process improvements.

Reporting, Governance & Stakeholder Management

• Develop executive summaries, project status reports, dashboards, and presentations for leadership.
• Present project updates, risks, audit findings, and recommendations to leadership and cross-functional stakeholders.
• Facilitate governance meetings and ensure follow-up on key decisions and action items.
• Build and maintain strong working relationships with providers, delegated entities, vendors, and internal business partners.
• Support departmental goals, strategic initiatives, and special projects assigned.

Preferred Qualifications

• Medicare Advantage health plan experience.
• Experience serving as a primary point of contact during an NCQA HEDIS Compliance Audit.
• Experience with HEDIS universe validation, source-data verification, and data lineage review.
• Experience supporting CMS Star Ratings programs and quality improvement initiatives.
• Experience  with healthcare analytics, HEDIS software platforms, and data validation tools.
• Formal project management experience within a healthcare, managed care, or regulatory environment.
• Experience developing executive-level reports, project plans, and governance materials.

Professional Competencies

• Advanced project planning, organization, and execution skills.
• Strong understanding of NCQA HEDIS Compliance Audit requirements and methodologies.
• Ability to manage multiple complex projects simultaneously and meet critical deadlines.
• Strong stakeholder management and cross-functional leadership capabilities.
• Exceptional  attention to detail and commitment to data integrity and compliance.
• Strong analytical, problem-solving, and critical-thinking skills.
• Ability to identify risks and proactively develop mitigation strategies.
• Effective facilitation, presentation, and communication skills.
• Ability to influence outcomes and drive accountability without direct authority.
• Self-motivated with the ability to work independently in a fast-paced environment.

Verda cares deeply about the future, growth, and well-being of its employees. Join our team today!

Job Type: Full-time employment
Location: Huntington Beach, CA

Compensation Range: $71,000-85,000

Actual compensation offered will be determined based on experience, qualifications, skills, internal equity (if available), and geographic location. This position may also be eligible for performance-based incentive compensation and benefits.

Benefits:

• 401(k)
• Paid time off (vacation, holiday, sick leave)
• Health insurance 
• Dental Insurance
• Vision insurance 
• Life insurance

Schedule:

• Full-time onsite (100% in-office)
• Hours of operations: 9am – 6pm
• Standard business hours Monday to Friday/weekends as needed
• Occasional travel may be required for meetings and training sessions.

Ability to commute/relocate:

• Reliably commute to the required office location, or planning to relocate before starting work.

PHYSICAL DEMANDS

Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.

* Other duties may be assigned in support of departmental goals.

• Bachelor’s degree in healthcare administration, Public Health, Nursing, Health Information Management, Business Administration, or related field required.
• Minimum of 3-5 years of healthcare quality experience within a health plan, IPA, MSO, managed care organization, or healthcare setting.
• Minimum of 2-3 years of HEDIS experience , including medical record review and abstraction.
• Experience supporting MAPD HEDIS reporting programs .
• Experience with NCQA HEDIS Compliance Audits and audit preparation activities.
• Knowledge of HEDIS technical specifications, medical record documentation requirements, and quality measurement methodologies.
• Experience working with delegated entities, providers, and healthcare vendors.
• Advanced proficiency with Microsoft Excel, Word, PowerPoint, and Outlook.
• Strong analytical and project coordination skills.