Remote Enrollment Quality Auditor (Medicaid/MLTC)

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

Job summary

HealthEdge is seeking an Enrollment Quality Auditor with Medicaid enrollment and eligibility operations experience. You will audit enrollment, disenrollment, eligibility redeterminations, and plan/PCP changes for a designated client, reporting audit findings to operations managers daily.

You will verify timely processing, share QA results with associates, coordinate with Team Leads for feedback, and stay current on CMS Medicaid guidelines.

Qualifications

• High School Diploma or GED required.
• 3 years health plan enrollment/eligibility auditing operations experience required.
• Medicaid managed care enrollment auditing experience preferred; MLTC or dual-eligible enrollment experience strongly preferred.

Responsibilities

• Audit enrollment, disenrollment, eligibility, and plan/PCP changes for a specific customer.
• Follow customer quality process and tools for audit and rebuttal; review 834 file transactions.
• Verify timely and accurate processing of Medicaid eligibility redeterminations and recertifications.
• Report QA results to associates and coordinate with Team Leads for feedback to individuals.
• Maintain currency on CMS Medicaid guidelines and state enrollment requirements.

Skills

MS Excel

PowerPoint

Outlook

Remote collaboration

Education

High School Diploma

Tools

HealthRules Payor

GuidingCare

EDI 834

Job description

HealthEdge is seeking an Enrollment Quality Auditor with Medicaid enrollment and eligibility operations experience. You will audit enrollment, disenrollment, eligibility redeterminations, and plan/PCP changes for a designated client, reporting audit findings to operations managers daily.

You will verify timely processing, share QA results with associates, coordinate with Team Leads for feedback, and stay current on CMS Medicaid guidelines.