Enrollment Quality Auditor

📋 Description

• Audit enrollment, disenrollment, eligibility, and plan or PCP change transactions
• Follow established quality processes, audit tools, and rebuttal procedures
• Review 834 enrollment file transactions and verify member data
• Verify timely processing of Medicaid eligibility redeterminations
• Audit dual-eligible Medicare-Medicaid enrollment coordination
• Communicate audit findings and collaborate with team leads

🎯 Requirements

• High school diploma or GED
• At least 3 years in health plan enrollment and eligibility auditing
• Experience with Medicaid managed care preferred
• Experience with MLTC or dual-eligible enrollment strongly preferred
• Familiarity with EDI 834 transactions preferred
• Experience with HealthRules Payor or GuidingCare preferred

🎁 Benefits

• Annual base salary performance
• Full-time permanent employment
• Fully remote work in the US
• Professional development opportunities
• Exposure to healthcare technology