Analytica · 20 hours ago
Eligibility Staff Auditor
United States
Full-time
Remote
Mid Level
3+ years expAnalytica is a leading consulting and information technology solutions provider to public sector organizations supporting health, civilian, and national security missions. The Medicaid Eligibility Auditor will conduct compliance audits and reviews of Medicaid and CHIP eligibility determinations, ensuring adherence to federal and state regulations while collaborating with various stakeholders.
AnalyticsBig DataBusiness IntelligenceConsulting
Responsibilities
Conduct detailed reviews of Medicaid and CHIP beneficiary eligibility determinations for compliance with federal and state regulations
Evaluate eligibility decisions related to applications, redeterminations, post-Public Health Emergency (PHE) unwinding, and subsequent policy changes
Assess state Medicaid eligibility policies, procedures, and workflows to ensure adherence to established guidelines
Identify, document, and communicate potential vulnerabilities, risks, and areas of non-compliance within state Medicaid programs
Gather and analyze state-provided documentation, including financial records, identity verification documents, and eligibility timelines
Utilize data analytics tools to identify patterns, trends, and risk indicators requiring deeper audit review
Prepare comprehensive audit reports summarizing findings, recommendations, and corrective action plans for submission to CMS/CPI and CMCS
Develop clear, concise supporting documentation to substantiate audit findings and conclusions
Collaborate with state Medicaid agencies to collect documentation and clarify procedural questions
Participate in team meetings to ensure alignment and consistency in review approaches
Conduct research to remain current on federal and state Medicaid eligibility regulations and evolving policy requirements
Communicate regulatory updates and provide subject matter guidance to team members
Assist in enhancing analytical tools, templates, and review protocols
Contribute to continuous improvement of audit processes and program integrity methodologies
Participate in training sessions to strengthen team capacity and maintain audit preparedness
Provide guidance and support to junior team members or reviewers as needed
Ensure all reviews align with established protocols, deadlines, and quality standards
Verify accuracy, completeness, and clarity of documentation and findings prior to submission
Maintain high productivity and organization in a fully remote work environment
Qualification
Required
Bachelor's degree in public health, business administration, public administration, accounting, or a related field
Candidates with an associate's degree may be considered if they have at least 10 years of highly relevant Medicaid eligibility and auditing experience
Minimum 3 years of experience with federal entitlement programs such as Medicaid or CHIP (1 year is acceptable with a master's degree)
Proven experience conducting compliance assessments, program reviews, or audits of federal or state programs
Proficiency with Microsoft Office applications and experience using analytical tools for data evaluation
Ability to develop clear technical reports and presentations
Strong understanding of Medicaid terminology, regulations, eligibility frameworks, and policy requirements
Familiarity with risk assessment techniques and program integrity principles
Excellent prioritization, organizational, and time-management abilities
Strong written and verbal communication skills, including the ability to collaborate with CMS, state agencies, and internal teams
Ability to work independently and make sound decisions within established processes
Ability to adapt effectively to a remote work environment
U.S. citizenship, Green Card, or valid work authorization (H1B)
Preferred
Master's degree preferred
Benefits
Competitive compensation
Opportunities for bonuses
Employer-paid healthcare
Training and development funds
401k match
Company
Analytica
Analytica has built a team of exceptionally dedicated analysts, associates and public sector subject matter experts.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Mariano Lopez
CEO
Regina Dull
Chief Financial Officer
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