Remote Enrollment Quality Auditor (Medicaid)

HealthEdge; United States; Remote; USD 44,000 - 50,000; Full time

Job summary

HealthEdge is seeking an Enrollment Quality Auditor to audit Medicaid enrollment and eligibility transactions for a designated customer. The role requires independent work and strong collaboration with remote teams, reporting findings to QA leadership.

The ideal candidate has 3 years of health plan enrollment auditing experience, a High School Diploma or GED, and proficiency with MS Excel, PowerPoint, and Outlook. Familiarity with HealthRules Payor or GuidingCare and EDI 834 is a plus.

Qualifications

• High School Diploma or GED required.
• 3 years health plan enrollment/eligibility auditing operations experience required.
• Proficiency in MS Excel, PowerPoint and Outlook.
• HealthRules Payor or GuidingCare experience preferred; familiarity with EDI 834 enrollment transactions a plus.
• Ability to analyze contractual SLAs and KPIs, particularly around enrollment processing timeliness.
• Ability to effectively communicate and collaborate with a remote team.

Responsibilities

• Audit enrollment, disenrollment, eligibility, and plan/PCP change transactions for a specific customer.
• Review enrollment (834) file transactions and coordinate with state enrollment systems and enrollment brokers.
• Verify timely and accurate processing of Medicaid eligibility redeterminations and recertifications against CMS and state timeliness standards.
• Audit dual-eligible enrollment coordination, aligning Medicare and Medicaid eligibility segments.
• Share QA results with associates and provide feedback to individuals and teams.
• Collate and report QA performance to management and individuals.

Skills

MS Excel

PowerPoint

Outlook

Remote collaboration

Analytical skills

Communication

Education

High School Diploma or GED

Tools

HealthRules Payor

GuidingCare

EDI 834

Job description

HealthEdge is seeking an Enrollment Quality Auditor to audit Medicaid enrollment and eligibility transactions for a designated customer. The role requires independent work and strong collaboration with remote teams, reporting findings to QA leadership.

The ideal candidate has 3 years of health plan enrollment auditing experience, a High School Diploma or GED, and proficiency with MS Excel, PowerPoint, and Outlook. Familiarity with HealthRules Payor or GuidingCare and EDI 834 is a plus.