Eligibility Auditor

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Analytica

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

📦 Logistics

📣 Marketing

Healthcare • Logistics • Marketing

Analytica is a rapidly growing SBA-Certified 8(a) Small Business that specializes in providing advanced analytics, digital transformation, and enterprise data management services primarily to federal agencies. The company focuses on simplifying complex data to enable its clients to make informed decisions, thereby driving success in their missions and citizen services. With a strong emphasis on management consulting and federal technology training, Analytica employs a data-driven approach to enhance the capabilities of government IT systems and organizations. The company is renowned for its collaborative culture and commitment to employee development, ensuring quality service delivery. Analytica is recognized for its support in public sector innovation and adheres to industry standards like Agile, SAFe, and CMMI. Their mission is to assist the government in utilizing digital tools and data analytics to improve service delivery to citizens.

📋 Description

• 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