Eligibility Auditor

This is a fully remote position, open to applicants in United States.

📋 Description

• Perform comprehensive evaluations of Medicaid and CHIP beneficiary eligibility determinations to ensure adherence to federal and state regulations.

• Analyze eligibility decisions related to applications, redeterminations, post-PHE unwinding, and subsequent policy updates.

• Review state Medicaid eligibility policies, procedures, and workflows.

• Identify, document, and communicate vulnerabilities, risks, and instances of non-compliance.

• Collect and assess state-provided documentation, including financial records, identity verification materials, and eligibility timelines.

• Utilize data analytics tools to uncover patterns, trends, and risk indicators.

• Create audit reports that summarize findings, recommendations, and corrective action plans for CMS/CPI and CMCS.

• Develop supporting documentation for audit findings and conclusions.

• Collaborate with state Medicaid agencies and actively participate in team meetings.

• Stay informed on current federal and state Medicaid eligibility regulations and relay updates as necessary.

• Assist with analytical tools, templates, review protocols, and ongoing process enhancements.

• Engage in training sessions and provide support to junior team members or reviewers.

• Ensure that reviews adhere to protocols, deadlines, quality standards, accuracy, completeness, and clarity requirements.

⛳️ Requirements

• Bachelor’s degree in public health, business administration, public administration, accounting, or a related discipline.

• Master’s degree is preferred.

• An Associate’s degree may be acceptable with a minimum of 10 years of relevant Medicaid eligibility and auditing experience.

• At least 3 years of experience with federal entitlement programs such as Medicaid or CHIP; 1 year is acceptable with a master’s degree.

• Experience in conducting compliance assessments, program reviews, or audits of federal or state programs.

• Proficient in Microsoft Office applications.

• Familiarity with analytical tools for data evaluation.

• Capable of developing clear technical reports and presentations.

• Strong understanding of Medicaid terminology, regulations, eligibility frameworks, and policy requirements.

• Knowledge of risk assessment techniques and program integrity principles.

• Excellent prioritization, organization, and time-management skills.

• Strong written and verbal communication abilities.

• Capacity to collaborate with CMS, state agencies, and internal teams.

• Ability to work independently and make informed decisions within established processes.

• Adaptability to effectively function in a remote work environment.

• U.S. citizenship is required.

• Must be eligible to obtain Public Trust Clearance.

🏝️ Benefits

• Opportunities for bonuses.

• Employer-funded healthcare.

• Training and development resources.

• 401k matching.

• Fully remote work setting.