Medicaid Audit Resolution Specialist - Remote

Health & Human Services; United States; Remote; USD 53,000 - 92,000; Full time

Benefits offered by this job

Fully remote work option

Job summary

The North Carolina Department of Health and Human Services (DHHS) is seeking an Audit Resolution Consultant to support Medicaid by calculating erroneous payments, verifying service codes in NCTracks, and coordinating with auditors and CPAs to strengthen audit processes.

The role emphasizes safeguarding program integrity, documenting findings, and ensuring counties are financially responsible under NC statutes.

Qualifications

• Master's or Bachelor's degree in a related field with related experience.
• Minimum years of experience navigating NCFAST and NCTracks systems.
• Experience reviewing Medicaid eligibility audit findings and calculating erroneous payments.
• Ability to communicate with internal and external stakeholders to support audit coordination.
• Proven experience analyzing Medicaid claims and eligibility discrepancies.

Responsibilities

• Compute erroneous Medicaid payment amounts by determining state and federal responsibility based on county errors.
• Examine county eligibility error findings across audits to identify overpayments.
• Review NCTracks claims data to verify service codes, amounts, and eligibility history.
• Coordinate with Local Government Commission and CPAs to establish audit requirements.
• Document findings and payment calculations to support reconciliation processes.
• Support oversight to ensure counties are financially responsible for erroneous issuances.
• Evaluate audit outcomes and propose improvements to error-detection processes.
• Maintain accurate records of audit data and correspondence for reporting.

Skills

NCFAST navigation

NCTracks experience

Audit coordination

Stakeholder communication

Data analysis

Education

Master's degree in related field

Bachelor's degree in related field

Tools

NCFAST

NCTracks

Job description

The North Carolina Department of Health and Human Services (DHHS) is seeking an Audit Resolution Consultant to support Medicaid by calculating erroneous payments, verifying service codes in NCTracks, and coordinating with auditors and CPAs to strengthen audit processes.

The role emphasizes safeguarding program integrity, documenting findings, and ensuring counties are financially responsible under NC statutes.