Eligibility Staff Auditor

Analytica•Washington, DC

21d•Remote

About The Position

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.

Requirements

Bachelor’s degree in public health, business administration, public administration, accounting, or a related field.
Minimum 3 years of experience with federal entitlement programs such as Medicaid or CHIP (1 year is 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.
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).

Nice To Haves

Master’s degree preferred.
Candidates with an associate’s degree may be considered if they have at least 10 years of highly relevant Medicaid eligibility and auditing experience.

Responsibilities

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.