Medicaid Audit & Overpayment Specialist (Remote)

Adult Correction; United States; Remote; USD 53,000 - 92,000; Full time

Benefits offered by this job

Fully remote work option

Job summary

North Carolina Department of Health and Human Services is seeking an Audit Resolution Consultant to support Medicaid by computing erroneous payments and validating eligibility data. The role requires examining county findings, reviewing NCTracks data, and coordinating with the Local Government Commission and State Auditor to strengthen audit processes.

This position is funded in part through federal funds and is eligible for a fully remote work option, with duties focused on ensuring financial

Qualifications

• Experience navigating NCFAST system decisions and functionality.
• Experience navigating NCTracks (MMIS) system functionality to obtain service codes and eligibility history.
• Proven ability to review Medicaid eligibility audit findings and support erroneous payment assessments.
• Strong communication with internal and external stakeholders to coordinate audit activities.
• Ability to analyze Medicaid claims and eligibility discrepancies using system data.

Responsibilities

• Compute erroneous Medicaid payment amounts based on state and federal responsibility.
• Examine county eligibility error findings across audits to identify overpayments.
• Review NCTracks claims data to verify codes, amounts, and eligibility histories.
• Analyze erroneous Medicaid issuance data to determine ineligible payments and dates.
• Coordinate with Local Government Commission, CPAs, and State Auditor to improve audit requirements.
• Liaise with internal and external stakeholders to support audit activities and compliance.
• Document audit findings and payment calculations to support reconciliation processes.
• Support oversight activities to ensure counties' financial responsibility for erroneous issuances.
• Evaluate audit outcomes and identify opportunities to strengthen error-detection.
• Maintain accurate records of audit data and correspondence for reporting needs.

Skills

NCFAST navigation

NCTracks navigation

Stakeholder communication

Medicaid claims analysis

Audit risk assessment

Tools

NCFAST system

NCTracks MMIS

Job description

North Carolina Department of Health and Human Services is seeking an Audit Resolution Consultant to support Medicaid by computing erroneous payments and validating eligibility data. The role requires examining county findings, reviewing NCTracks data, and coordinating with the Local Government Commission and State Auditor to strengthen audit processes.

This position is funded in part through federal funds and is eligible for a fully remote work option, with duties focused on ensuring financial