Stars Audit and Compliance Documentation
Comprehensive governance framework for HEDIS measure auditing
Project Overview
A complete documentation and audit package designed to survive a CMS data validation audit. It includes detailed measure specifications, data lineage maps, version-controlled SQL logic, and automated audit trail logs.
The Challenge
Data audits are high-stress events. Missing documentation or untraceable data changes can lead to failed audits and financial penalties. The organization lacked a centralized, audit-ready repository.
Key Results
- Passed a mock CMS data validation audit with zero major findings.
- Reduced the time required to answer auditor questions from days to hours.
- Instilled a culture of 'audit-readiness' across the data engineering team.
Technical Solution
- 1
Created a 'Measure Dictionary' detailing the business logic, data sources, and exclusions for every metric.
- 2
Implemented automated SQL audit logs that track every row change, insertion, and deletion in the measure tables.
- 3
Built a data lineage visualizer to trace any metric back to its source claims and member records.
- 4
Established a rigorous change management process for all measure calculation code.