Remote Medicaid Audit Resolution Consultant

State of North Carolina; United States; Remote; USD 53,000 - 92,000; Full time

Benefits offered by this job

Remote work option

Job summary

North Carolina Department of Health and Human Services (DHHS) seeks an Audit Resolution Consultant I to support Medicaid by computing erroneous payments and verifying service codes and eligibility histories. You will coordinate with state and local partners to strengthen audit processes and ensure statutory compliance.

This role emphasizes accurate reconciliation of erroneous issuances, collaboration with CPAs and office auditors, and maintaining comprehensive audit records.

Qualifications

• Master's degree in a discipline relative to the program from an appropriately accredited institution.
• Bachelor's degree in a discipline relative to the program area from an appropriately accredited institution.
• Equivalent combination of education and experience may apply.

Responsibilities

• Compute erroneous Medicaid payment amounts based on state and federal financial responsibility.
• Examine county eligibility error findings across audits to identify overpayments.
• Review NCTracks claims data to verify service codes, amounts, and eligibility history.
• Analyze erroneous Medicaid benefit issuance data to determine ineligible payments.
• Coordinate with Local Government Commission and CPAs to establish audit requirements.
• Liaise with internal and external stakeholders to support audit activities.
• Document audit findings and payments calculations for reconciliation.
• Support oversight under NC statute 108A‑25.1A to hold counties responsible.
• Evaluate audit outcomes to improve error-detection and accountability.
• Maintain accurate records of audit data and correspondence.

Skills

NCFAST

NCTracks

Audit findings

Stakeholder comms

Medicaid claims analysis

Education

Master's degree

Bachelor's degree

Tools

NCFAST

NCTracks

Job description

North Carolina Department of Health and Human Services (DHHS) seeks an Audit Resolution Consultant I to support Medicaid by computing erroneous payments and verifying service codes and eligibility histories. You will coordinate with state and local partners to strengthen audit processes and ensure statutory compliance.

This role emphasizes accurate reconciliation of erroneous issuances, collaboration with CPAs and office auditors, and maintaining comprehensive audit records.