Remote Medicaid Enrollment Quality Auditor

HealthEdge Software, Inc.; Northern (KY); Hybrid; USD 44,000 - 50,000; Full time

Job summary

HealthEdge Software, Inc. is seeking an Enrollment Quality Auditor to join our remote team across the US. You will audit enrollment transactions, review 834 files, and ensure Medicaid eligibility redeterminations meet CMS standards, collaborating with client audit teams and operations managers.

The ideal candidate has 3+ years in health plan enrollment auditing, strong MS Office skills, and familiarity with Medicaid/MLTC or dual-eligible enrollment. Travel may be required.

Qualifications

• 3 years health plan enrollment/eligibility auditing operations experience.
• Proficiency in MS Office Suite, specifically 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 around enrollment processing timeliness.

Responsibilities

• Audit enrollment, disenrollment, eligibility, and plan/PCP changes for a specific customer.
• Review 834 file transactions and coordinate with state enrollment systems.
• Verify Medicaid eligibility redeterminations and recertifications per CMS standards.
• Coordinate with QA results and provide feedback to associates for improvement.
• Report QA performance to management and assist with training inputs.

Skills

MS Excel

PowerPoint

Outlook

Communication

Teamwork

Education

High School Diploma or GED

Tools

HealthRules Payor

GuidingCare

EDI 834

Job description

HealthEdge Software, Inc. is seeking an Enrollment Quality Auditor to join our remote team across the US. You will audit enrollment transactions, review 834 files, and ensure Medicaid eligibility redeterminations meet CMS standards, collaborating with client audit teams and operations managers.

The ideal candidate has 3+ years in health plan enrollment auditing, strong MS Office skills, and familiarity with Medicaid/MLTC or dual-eligible enrollment. Travel may be required.