Remote Audit Resolution Specialist - Medicaid Integrity

State of North Carolina - Health & Human Services; North Carolina; Remote; USD 53,000 - 92,000; Full time

Job summary

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.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Stakeholder communication

Analytical skills

Attention to detail

Education

Master's degree in a relevant field

Bachelor's degree in a relevant field

Tools

NCFAST

NCTracks (MMIS)

Job description

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.