Audit Resolution Consultant

State of North Carolina - Health & Human Services; North Carolina; A distancia; USD 53.000 - 92.000; Jornada completa

Descripción de la vacante

The State of North Carolina - Health & Human Services is seeking an Audit Resolution Consultant to support Medicaid by computing erroneous payments and reviewing county eligibility errors across audits. The role emphasizes accuracy, stakeholder coordination, and program integrity.

Responsibilities include analyzing NCTracks data, documenting findings, and coordinating with auditors and CPAs to strengthen audit processes. Remote option may be available with state-specific guidelines.

Formación

• Experience navigating NCFAST system decisions and functionality at intermediate or higher proficiency, with at least three years of documented use.
• Experience navigating NCTracks (MMIS) system functionality to obtain and interpret service codes, claims amounts, and beneficiary eligibility history, with at least three years of experience.
• Experience reviewing Medicaid eligibility audit findings to support accurate assessment of erroneous payments and overpayments.

Responsabilidades

• Compute erroneous Medicaid payment amounts by determining 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 overpayment amounts.
• Review claims payment data in NCTracks to verify service codes, claims amounts, and beneficiary eligibility history.
• Analyze erroneous Medicaid benefit issuance data to determine when payments were made for ineligible individuals, dates, or amounts.
• Coordinate with 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 audit activities and ensure compliance with statutory requirements.
• Document audit findings and payment calculations to support financial reconciliation processes.
• Support oversight activities required under NC General Statute 108A‑25.1A to ensure counties are financially responsible for erroneous Medicaid issuances.

Conocimientos

Stakeholder communication

Analytical skills

Attention to detail

Educación

Master's degree in a relevant field

Bachelor's degree in a relevant field

Herramientas

NCFAST

NCTracks (MMIS)

Descripción del empleo

AgencyDept of Health and Human ServicesDivisionHEALTH BENEFITSJob Classification TitleHuman Services Program Consultant I (NS)Position Number60042904GradeNC14About UsThe North Carolina Department of Health and Human Services (DHHS) is one of the largest, most complex agencies in the state, and has approximately 17,000 employees. It is responsible for ensuring the health, safety, and well-being of all North Carolinians, providing human service needs for special populations including individuals who are deaf, blind, developmentally disabled, and mentally ill, and helping poor North Carolinians achieve economic independence.Description of WorkThe Audit Resolution Consultant supports North Carolina Medicaid by computing erroneous payments of state and federal shares resulting from eligibility errors made by county departments of social services.The position examines county eligibility error findings across state and federal audits to accurately determine county overpayment amounts and reviews claims data using NCTracks to verify service codes, amounts, and eligibility histories. It coordinates with the Local Government Commission, local Certified Public Accountants, and the Office of the State Auditor to establish functional audit requirements and strengthen audit processes.The Audit Resolution Consultant operates within the Office of Compliance & Program Integrity and ensures financial accountability by applying statutory requirements under N.C. General Statute 108A‑25.1A. This position contributes to Medicaid program integrity by supporting accurate reconciliation of erroneous benefit issuances and claims payments.Key Duties Include:– Compute erroneous Medicaid payment amounts by determining 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 overpayment amounts.– Review claims payment data in NCTracks to verify service codes, claims amounts, and beneficiary eligibility history.– Analyze erroneous Medicaid benefit issuance data to determine when payments were 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 ensure compliance with statutory requirements.– Document audit findings and payment calculations to support financial reconciliation processes.– Support oversight activities required 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 records of audit data, calculations, and correspondence to support program integrity and reporting needs.Knowledge Skills and Abilities/Management PreferencesSalary Grade Range: $52,592.00 - $92,036.00Candidates now meet the minimum qualifications of a position if they meet the minimum education and experience listed on the vacancy announcement.The Knowledge, Skills, and Abilities (KSAs)/ Management Preferences are not required. Applicants who possess the following skills are preferred:Demonstrated experience navigating, evaluating, and analyzing NCFAST system decisions and functionality at an intermediate or higher proficiency level, with at least three years of documented use.Track record navigating and evaluating NCTracks (MMIS) system functionality to obtain and interpret service codes, claims amounts, and beneficiary eligibility history, supported by at least three years of experience.Documented experience reviewing and interpreting state or county Medicaid eligibility audit findings to support accurate assessment of erroneous payments and overpayment determinations.Proven success communicating effectively with internal and external stakeholders to support audit coordination, error resolution, and program integrity activities.Established experience analyzing Medicaid claims and eligibility discrepancies using system‑derived data to support accurate computation of erroneous payments and audit outcomes.The Posting Will Close At 11:59 P.M. The Night Before The End DateThis Position Is Funded In Part Through Federal FundsThis Position Is Eligible For A Fully Remote Work OptionEHRA: Per G.S. 126-5(c1) (37), This Position Is EXEMPT From All Provisions Of NC General Statute Chapter 126 (State Human Resources Act) With The Exception Of Articles 6 And 7Physical Requirements:Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, or pull or otherwise move objects including the subject’s own body.Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally, and other sedentary criteria are met.About the NC Division of Health Benefits:The Division of Health Benefits (DHB) within NCDHHS is committed to advancing innovative solutions that improve health, promote well-being and foster independence for all North Carolinians. DHB manages and oversees North Carolina Medicaid and other programs that provide access to services and supports for parents, children, seniors, people with intellectual / developmental disabilities, and behavioral health, substance use and traumatic brain injury disorders. With a budget over $27 billion in state and federal funds per fiscal year, DHB ensures that more than 108,000 enrolled providers are reimbursed for delivering covered services to 3.1 million beneficiaries.All positions in the Division of Health Benefits are exempt from the State Human Resources Act (G.S. 126) except for the provisions of Articles 6 and 7 per HB 372 Section 20.Compensation and Benefits:The State of North Carolina offers excellent comprehensive benefits. Employees can participate in health insurance options, standard and supplemental retirement plans, and the NCFlex program (numerous high-quality, low-cost benefits on a pre-tax basis). Employees also receive paid vacation, sick, and community service leave. In addition, paid parental leave is available to eligible employees.Visit the website for State Benefits .Supplemental Contact Information:The North Carolina Department of Health and Human Services (DHHS) is an Equal Opportunity Employer that embraces an Employment First philosophy, which consists of complying with all federal laws, state laws, and Executive Orders. We are committed to reviewing requests for reasonable accommodation at any time during the hiring process or while on the job. For more information about DHHS: https://www.ncdhhs.gov/ .DHHS uses the Merit-Based Recruitment and Selection Plan to fill positions subject to the State Human Resources Act with the most qualified individuals. Hiring salary will be based on relevant qualifications, internal equity, and budgetary considerations pertinent to the advertised position.In accordance with the Governor’s Executive Order 303 , our agency supports second-chance employment for individuals who were previously incarcerated or justice-involved. We invite all potential applicants to apply for positions for which they may be qualified.Application ProcessBe sure to complete the application in its entirety. Resumes will not be accepted in lieu of completing this application.Information should be provided in the appropriate areas, to include the following: Education, including high school and all degrees obtained, Work Experience, and Certificates & Licenses. It is critical to our screening and salary determination process that applications contain comprehensive candidate information.Answers to Supplemental Questions are not a substitute for providing all relevant information within the body of your application. To receive credit for the supplemental questions, you must provide supporting information within the \"Work Experience\" section of the application to support your answers.If multiple applications are submitted to an individual posting, only the most recent application received prior to the closing date will be accepted. Applications must be submitted by 11:59 PM on the closing date.Applicants may be subject to a criminal background check. All candidates selected for positions considered \"Positions of Trust\" will be subject to a criminal background check.Due to the volume of applications received, we are unable to provide information regarding the status of your application over the phone. To check the status of your application, please log in to your account. Upon the closing date, applications are \"Under Review\" and will be screened by Human Resources for qualified applicants. The hiring process may take several weeks.Degrees must be received from appropriately accredited institutions. Transcripts and degree evaluations may be uploaded with your application. The State of North Carolina/Office of State Human Resources uses the National Association of Credential Evaluation Services (NACES) as a referral resource for applicants who need to have their credentials certified as equivalent.For a list of organizations that perform this specialized service, please visit the NACES membership website at https://www.naces.org/members .Degree/College Credit VerificationDegrees must be received from appropriately accredited institutions. Transcripts, degree evaluations, and cover letters may be uploaded with your application.Veterans’ and National Guard PreferenceApplicants seeking Veteran's Preference must attach a DD-214 Member-4 Form (Certificate of Release or Discharge from Active Duty) to their applications.Applicants seeking National Guard Preference must attach an NGB 23A (RPAS), along with the state application, if they are a current member of the NC National Guard in good standing.Applicants who are former members of either the NC Army National Guard or the NC Air National Guard, with honorable discharge and six years of creditable service, must attach a copy of the DD 256 or NGB 22, along with the state application.ADA AccommodationsConsistent with the Americans with Disabilities Act (ADA) and the Pregnant Workers Fairness Act (PWFA), DHHS is committed to the full inclusion of all qualified individuals. As part of this commitment, DHHS will ensure that people with disabilities, or known limitations covered by the PWFA, are provided with reasonable accommodation. If reasonable accommodation is needed to participate in the job application or interview process, please contact the person indicated below.CONTACT INFORMATIONIf there are any questions about this posting, please contact Talent Acquisition at [e-mail] . Resumes will not be accepted in lieu of completing this application.Minimum Education and ExperienceSome state job postings say you can qualify by an “equivalent combination of education and experience.” If that language appears below, then you may qualify through EITHER years of education OR years of directly related experience, OR a combination of both. See the Education and Experience Equivalency Guide for details.Master's degree in a discipline relative to the program from an appropriately accredited institution and two years of related experienceORBachelor's degree in a discipline relative to the program area from an appropriately accredited institution and four years of related experienceORAn equivalent combination of education and experience.EEO StatementT he State of North Carolina is an Equal Employment Opportunity Employer and dedicated to providing employees with a work environment free from all forms of unlawful employment discrimination, harassment, or retaliation. The state provides reasonable accommodation to employees and applicants with disabilities; known limitations related to pregnancy, childbirth, or related medical conditions; and for religious beliefs, observances, and practices.Recruiter:Tresha WalkerContact:DHHS Workday Support Form