Eligibility Staff Auditor

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an Eligibility Staff Auditor based in the United States.

This role supports a major Medicaid program integrity initiative focused on strengthening the accuracy, compliance, and accountability of public healthcare <programs.You> will review Medicaid and CHIP eligibility determinations against federal and state requirements, identifying risks, inconsistencies, and potential areas of non-compliance.The position combines audit expertise, regulatory research, data analysis, and technical reporting in a fully remote <environment.You>’ll collaborate with state Medicaid agencies and federal stakeholders while helping translate complex findings into actionable recommendations.The role also contributes to improving audit methodologies, analytical tools, review protocols, and team <capabilities.It> is well suited to an analytical professional who can work independently while maintaining strong quality, organization, and attention to detail.This temporary, mid-level opportunity offers meaningful exposure to federal healthcare oversight and program integrity work.

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.