Eligibility Staff Auditor

Accountabilities

• • Conduct detailed reviews of Medicaid and CHIP beneficiary eligibility determinations to assess compliance with applicable federal and state regulations.
  • Evaluate eligibility decisions involving applications, redeterminations, post-Public Health Emergency unwinding activities, and subsequent policy changes.
  • Review state Medicaid eligibility policies, procedures, and workflows for adherence to established requirements and guidelines.
  • Gather and analyze documentation such as financial records, identity verification materials, eligibility timelines, and other supporting evidence.
  • Use data analytics tools to identify trends, patterns, anomalies, and risk indicators requiring further audit review.
  • Identify, document, and communicate vulnerabilities, compliance risks, control gaps, and other areas requiring corrective action.
  • Prepare comprehensive audit reports, findings, recommendations, and corrective action documentation for federal program stakeholders.
  • Develop clear and well-supported workpapers and documentation that substantiate audit findings and conclusions.
  • Collaborate with state Medicaid agencies to obtain records, resolve questions, and clarify eligibility procedures or processes.
  • Conduct ongoing regulatory and policy research to remain current on Medicaid eligibility requirements and evolving program guidance.
  • Provide subject matter guidance and communicate regulatory updates to team members as appropriate.
  • Contribute to the enhancement of analytical tools, templates, review protocols, and program integrity methodologies.
  • Participate in team meetings, training activities, and continuous improvement initiatives to promote consistent and high-quality audit practices.
  • Provide guidance and support to junior reviewers when needed.
  • Ensure reviews are completed according to established protocols, deadlines, productivity expectations, and quality standards.
  • Verify the accuracy, completeness, and clarity of documentation and findings before submission.
  • Maintain strong organization, productivity, and communication while working within a fully remote team.

  Requirements

  • Bachelor’s degree in public health, business administration, public administration, accounting, or a related discipline; a master’s degree is preferred.
  • Candidates with an associate’s degree may be considered with at least 10 years of highly relevant Medicaid eligibility and auditing experience.
  • At least 3 years of experience working with federal entitlement programs such as Medicaid or CHIP, or 1 year of relevant experience with a master’s degree.
  • Demonstrated experience conducting compliance assessments, program reviews, audits, or similar oversight activities involving federal or state programs.
  • Strong knowledge of Medicaid terminology, eligibility frameworks, regulations, policies, and program requirements.
  • Familiarity with risk assessment methodologies and program integrity principles.
  • Proficiency with Microsoft Office applications and analytical tools used for data evaluation.
  • Strong ability to develop clear, concise technical reports, presentations, and supporting audit documentation.
  • Excellent written and verbal communication skills, with the ability to collaborate effectively with government agencies, internal teams, and other stakeholders.
  • Strong analytical thinking, attention to detail, prioritization, organization, and time-management skills.
  • Ability to work independently, exercise sound judgment, and make decisions within established processes and protocols.
  • Adaptability and demonstrated effectiveness working in a fully remote environment.
  • U.S. citizenship and ability to obtain Public Trust clearance.

  Benefits

  • Fully remote work environment within the United States.
  • Competitive compensation package with potential bonus opportunities.
  • Employer-paid healthcare benefits.
  • 401(k) retirement plan with employer matching.
  • Access to training and professional development funding.
  • Opportunity to contribute to a high-impact federal healthcare oversight and program integrity initiative.
  • Collaborative environment with exposure to Medicaid, CHIP, compliance, audit, analytics, and federal program operations.
  • Opportunity to develop expertise in healthcare program integrity and government auditing.