• Conduct detailed reviews of Medicaid and CHIP beneficiary eligibility determinations for compliance with federal and state regulations • Evaluate eligibility decisions related to applications, redeterminations, post-Public Health Emergency (PHE) unwinding, and subsequent policy changes • Assess state Medicaid eligibility policies, procedures, and workflows to ensure adherence to established guidelines • Identify, document, and communicate potential vulnerabilities, risks, and areas of non-compliance within state Medicaid programs • Gather and analyze state-provided documentation, including financial records, identity verification documents, and eligibility timelines • Utilize data analytics tools to identify patterns, trends, and risk indicators requiring deeper audit review • Prepare comprehensive audit reports summarizing findings, recommendations, and corrective action plans for submission to CMS/CPI and CMCS • Develop clear, concise supporting documentation to substantiate audit findings and conclusions • Collaborate with state Medicaid agencies to collect documentation and clarify procedural questions • Participate in team meetings to ensure alignment and consistency in review approaches • Conduct research to remain current on federal and state Medicaid eligibility regulations and evolving policy requirements • Communicate regulatory updates and provide subject matter guidance to team members • Assist in enhancing analytical tools, templates, and review protocols • Contribute to continuous improvement of audit processes and program integrity methodologies • Participate in training sessions to strengthen team capacity and maintain audit preparedness • Provide guidance and support to junior team members or reviewers as needed • Ensure all reviews align with established protocols, deadlines, and quality standards • Verify accuracy, completeness, and clarity of documentation and findings prior to submission • Maintain high productivity and organization in a fully remote work environment