Eligibility Staff Auditor

Analytica
Washington
Workplace: RemoteTemporaryFunction: Finance & AccountingExperience: 3+ yearsEducation: bachelorsSkills: ["Analytical thinking","Compliance mindset","Audit readiness","Communication","Organizational skills"]

Support the State Medicaid Program Integrity Audit (SMPIA) by reviewing Medicaid and CHIP beneficiary eligibility determinations for compliance with federal and state rules. Assess eligibility decisions across applications, redeterminations, and post–PHE unwinding policy changes, evaluate state workflows and policies, and identify risks, vulnerabilities, and non-compliance. Analyze documentation and data using analytics tools, then produce audit reports and collaborate with state agencies and CMS stakeholders to drive corrective action plans.

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FursaFursa
Analytica
Analytica
4 days ago

Eligibility Staff Auditor

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Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI
Last checked: 5 hours agoStatus: Live
Reposted: similar role first listed 6 months ago

Job Summary

Support the State Medicaid Program Integrity Audit (SMPIA) by reviewing Medicaid and CHIP beneficiary eligibility determinations for compliance with federal and state rules. Assess eligibility decisions across applications, redeterminations, and post–PHE unwinding policy changes, evaluate state workflows and policies, and identify risks, vulnerabilities, and non-compliance. Analyze documentation and data using analytics tools, then produce audit reports and collaborate with state agencies and CMS stakeholders to drive corrective action plans.
Location: Washington
Workplace: Remote
Employment Type: Temporary
Job Function: Finance & Accounting

Key Responsibilities

  • •Conduct detailed reviews of Medicaid and CHIP beneficiary eligibility determinations for compliance with federal and state regulations.
  • •Assess eligibility decisions for applications, redeterminations, and post-PHE unwinding policy changes.
  • •Evaluate state Medicaid eligibility policies, procedures, and workflows to ensure adherence to established guidelines.
  • •Identify, document, and communicate vulnerabilities, risks, and areas of non-compliance, and analyze state-provided documentation and eligibility timelines.
  • •Prepare comprehensive audit reports with findings, recommendations, and corrective action plans for CMS/CPI and CMCS, collaborating with state agencies as needed.

Pay and Benefits

Perks:Health Insurance401kLearning Budget

Key Requirements

  • •Bachelor’s degree in public health, business administration, public administration, accounting, or a related field (master’s preferred).
  • •Minimum 3 years of experience with federal entitlement programs such as Medicaid or CHIP (1 year 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.
  • •Strong understanding of Medicaid terminology, regulations, eligibility frameworks, and policy requirements, with strong written and verbal communication for reporting to stakeholders.
Experience:3+ yearsMedicaidCHIPFederal entitlement programsProgram integrityComplianceAuditing
Education:Bachelor's in Public health, business administration, public administration, accounting, or a related field
Skills:Analytical thinkingCompliance mindsetAudit readinessCommunicationOrganizational skills
Tech Stack:Microsoft Office

Eligibility

Security Clearance:Public Trust

Company Brief

Analytica
Analytica is a federal-focused consulting and technology services firm delivering data, analytics, AI, and IT modernization solutions to health, civilian, and national security agencies in the U.S.
Industry: Consulting
Company Size: Medium (51 to 250 employees)
Revenue: USD 25M to 50M
Growth: Established Company
Headquarters: Washington, United States
Founded: 2009
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