Eligibility Staff Auditor

Washington, AR - USA

Monthly Salary: Not Disclosed

Posted on: Yesterday

Vacancies: 1 Vacancy

Job Summary

Analytica is seeking a Medicaid Eligibility Auditor to support the State Medicaid Program Integrity Audit (SMPIA) initiative a key federal oversight program focused on strengthening the integrity and accountability of Medicaid and CHIP across the United States. The ideal candidate will excel in a collaborative remote team environment and demonstrate strong analytical compliance and audit capabilities related to federal entitlement programs.

Analytica has been recognized by Inc. Magazine as one of the fastest-growing 250 businesses in the US for three consecutive years. We support U.S. government clients in health civilian and national security missions to build better solutions that impact Americans day-to-day lives. The company offers competitive compensation with opportunities for bonuses employer-paid healthcare training and development funds and a 401k match.

Responsibilities include (but are not limited to):

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.

Basic Qualifications:

Bachelors degree in public health business administration public administration accounting or a related field.
Masters degree preferred.
Candidates with an associates 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 masters 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).

AboutAnalytica:Analyticais a leading consulting and information technology solutions provider to public sector organizations supporting health civilian and national security missions. The company is an award-winning SBA certified 8(a) small businessthat hasbeen recognized byInc. Magazineeach of the past three years as one of the 250 fastest-growingcompanies in the U.S. Analytica specializes in providing software and systems engineering information management analytics & visualization agile project management and management consulting services. The companyis appraised by the Software Engineering Institute (SEI) at CMMI Maturity Level 3 and is an ISO 9001:2008 certified provider.

Analytica LLC is an Equal Opportunity Employer. We are committed to providing equal employment opportunities to all individuals regardless of race color religion sex sexual orientation gender identity national origin age disability or any other characteristic protected by applicable federal state or local law. As a federal contractor we comply with the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA) and take affirmative action to employ and advance in employment qualified protected veterans.

We ensure that all employment decisions are based on merit qualifications and business needs. We prohibit discrimination and harassment of any kind. Analytica LLC also provides reasonable accommodations to applicants and employees with disabilities in accordance with applicable laws

When receiving email communication from Analytica please ensure that the email domain is to verify its authenticity.

Required Experience:

Manager