Eligibility Staff Auditor

Overview

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.

• 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.

• Bachelor’s degree in public health, business administration, public administration, accounting, or a related field.

• 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
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• 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,…