Audit Resolution Consultant

State of North Carolina•Wake County, NC

4d•Remote

About The Position

The Audit Resolution Consultant supports North Carolina Medicaid by calculating erroneous state and federal payments resulting from eligibility errors made by county departments of social services. The position reviews county eligibility error findings from state and federal audits, analyzes Medicaid benefit issuance and claims data, and determines county overpayment amounts. It uses NCTracks to verify service codes, claims amounts, and beneficiary eligibility histories. Operating within the Office of Compliance & Program Integrity, the role coordinates with the Local Government Commission, local Certified Public Accountants, the Office of the State Auditor, and other stakeholders to establish functional audit requirements and strengthen audit processes. It supports financial accountability and reconciliation under N.C. General Statute 108A-25.1A by documenting audit findings and calculations, maintaining accurate records, and identifying opportunities to improve Medicaid error detection and accountability.

Requirements

Master's degree in a discipline relative to the program from an appropriately accredited institution and two years of related experience; or bachelor's degree in a discipline relative to the program area from an appropriately accredited institution and four years of related experience; or an equivalent combination of education and experience.

Nice To Haves

Intermediate or higher proficiency navigating, evaluating, and analyzing NCFAST system decisions and functionality, with at least three years of documented use.
At least three years of experience navigating and evaluating NCTracks (MMIS) functionality to obtain and interpret service codes, claims amounts, and beneficiary eligibility history.
Experience reviewing and interpreting state or county Medicaid eligibility audit findings to support assessment of erroneous payments and overpayment determinations.
Success communicating with internal and external stakeholders to support audit coordination, error resolution, and program integrity activities.
Experience analyzing Medicaid claims and eligibility discrepancies using system-derived data to compute erroneous payments and audit outcomes.

Responsibilities

Calculate erroneous Medicaid payment amounts and determine state and federal financial responsibility based on county eligibility errors.
Examine county eligibility error findings across state and federal audits to identify and calculate county overpayments.
Review NCTracks claims payment data to verify service codes, claims amounts, and beneficiary eligibility histories.
Analyze erroneous Medicaid benefit issuance data to identify payments made for ineligible individuals, dates, or amounts.
Coordinate with the Local Government Commission, local CPAs, and the Office of the State Auditor to establish audit requirements and improve service provision.
Liaise with internal and external stakeholders to support functional audit activities and compliance with statutory requirements.
Document audit findings and payment calculations to support financial reconciliation.
Support oversight under N.C. General Statute 108A-25.1A to ensure counties are held financially responsible for erroneous Medicaid issuances.
Evaluate audit outcomes and identify opportunities to strengthen Medicaid error detection and accountability processes.
Maintain accurate audit data, calculation, and correspondence records to support program integrity and reporting.