Auditor

• 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.

Eligibility Staff Auditor

IT Auditor

Auditor III

Clinical Eligibility Auditor

Senior IT Internal Auditor