Remote Medicaid Enrollment Quality Auditor

HealthEdge Software, Inc.; Idaho; Remote; USD 44,000 - 58,000; Full time

Job summary

HealthEdge Software, Inc. is seeking an Enrollment Quality Auditor with Medicaid enrollment and eligibility expertise. The role audits enrollment transactions and interfaces with client audit teams to ensure accurate processing and timely determinations across states and Medicaid programs.

Responsibilities include reviewing 834 transactions, coordinating with enrollment systems, and reporting QA results to management while supporting training updates for the team. Remote US work is supported.

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 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 SLAs and KPIs, particularly around enrollment processing timeliness.
• Ability to effectively communicate and collaborate with a remote team.

Responsibilities

• Perform audits of enrollment, disenrollment, eligibility, and plan/PCP change transactions.
• Review 834 file transactions and coordinate with state enrollment systems to confirm accuracy of dates and eligibility segments.
• Verify Medicaid eligibility redeterminations and recertifications against CMS and state timeliness standards.
• Audit dual-eligible enrollment coordination and alignment of Medicare and Medicaid eligibility.
• Share QA results and provide feedback to associates; identify errors and opportunities for improvement.
• Collate and report QA performance to management and individuals.
• Contribute to training materials and refresher training needs.

Skills

Remote team collaboration

SLA/KPI analysis

Analytical thinking

Auditing experience in health plan

Education

High School Diploma or GED

Tools

MS Excel

PowerPoint

Outlook

HealthRules Payor

GuidingCare

EDI 834 systems

Job description

HealthEdge Software, Inc. is seeking an Enrollment Quality Auditor with Medicaid enrollment and eligibility expertise. The role audits enrollment transactions and interfaces with client audit teams to ensure accurate processing and timely determinations across states and Medicaid programs.

Responsibilities include reviewing 834 transactions, coordinating with enrollment systems, and reporting QA results to management while supporting training updates for the team. Remote US work is supported.