Remote Medicaid Enrollment QA Auditor

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

Job summary

HealthEdge is seeking an Enrollment Quality Auditor to audit Medicaid enrollment/eligibility transactions, report QA findings, and collaborate with a remote team. This role requires 3 years of enrollment auditing experience and proficiency with MS Office tools.

Remote US-based position with potential travel, full-time permanent employment. Candidates must meet quality standards and stay current with CMS/state 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.
• Proficiency in MS Office Suite, specifically Excel, PowerPoint and Outlook.
• HealthRules Payor or GuidingCare experience preferred; familiarity with EDI 834 enrollment transactions and eligibility verification systems 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 transactions for a specific customer.
• Follow customer quality process and tools for audit and rebuttal process.
• Review enrollment (834) file transactions and coordination with state enrollment systems.
• Verify timely and accurate processing of Medicaid eligibility redeterminations.
• Audit dual-eligible enrollment coordination and alignment of Medicare/Medicaid segments.
• Share QA results with associates and provide feedback to individuals and managers.
• Collate and report QA performance to management and individuals.
• Provide inputs to Training for up-to-date processing instructions and refresher needs.
• Participate in Auditor calibration activities.

Skills

SLA/KPI analysis

Remote team communication

Auditing

Analytical thinking

Education

High School Diploma or GED

Tools

MS Excel

PowerPoint

Outlook

HealthRules Payor

GuidingCare

Job description

HealthEdge is seeking an Enrollment Quality Auditor to audit Medicaid enrollment/eligibility transactions, report QA findings, and collaborate with a remote team. This role requires 3 years of enrollment auditing experience and proficiency with MS Office tools.

Remote US-based position with potential travel, full-time permanent employment. Candidates must meet quality standards and stay current with CMS/state Medicaid guidelines.