Eligibility Auditor
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Job Description
Medicaid Eligibility Auditor supporting Analytica’s U.S. government consulting practice. Reviewing beneficiary determinations, identifying program risks, and preparing federal audit reports and corrective actions.
Responsibilities:
- Conduct detailed reviews of Medicaid and CHIP beneficiary eligibility determinations for compliance with federal and state regulations
- Evaluate eligibility decisions involving applications, redeterminations, post-PHE unwinding, and subsequent policy changes
- Assess state Medicaid eligibility policies, procedures, and workflows
- Identify, document, and communicate vulnerabilities, risks, and non-compliance
- Gather and analyze state-provided documentation, including financial records, identity verification documents, and eligibility timelines
- Use data analytics tools to identify patterns, trends, and risk indicators
- Prepare audit reports with 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 participate in team meetings
- Research current federal and state Medicaid eligibility regulations and communicate updates
- Assist with analytical tools, templates, review protocols, and continuous process improvement
- Participate in training sessions and support junior team members or reviewers
- Ensure reviews meet protocols, deadlines, quality standards, accuracy, completeness, and clarity requirements
Requirements:
- Bachelor’s degree in public health, business administration, public administration, accounting, or a related field
- Master’s degree preferred
- Associate’s degree may be considered with 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 acceptable with a master’s degree
- Experience conducting compliance assessments, program reviews, or audits of federal or state programs
- Proficiency with Microsoft Office applications
- 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
- Strong prioritization, organization, and time-management abilities
- Strong written and verbal communication skills
- 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
- Ability to obtain Public Trust Clearance
Benefits:
- Opportunities for bonuses
- Employer-paid healthcare
- Training and development funds
- 401k match
- Fully remote work environment
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