Eligibility Audit Team Lead

Analytica is seeking a Medicaid Eligibility Audit Team Lead to direct and assist staff in the review of state beneficiary eligibility determinations. These reviews assess whether states have accurately determined Medicaid and CHIP eligibility at initial application and at re-determination, in compliance with Federal and state eligibility requirements, and whether the appropriate Federal Medical Assistance Percentage (FMAP) was claimed for these beneficiaries. This candidate will support the State Medicaid Program Integrity Audit (SMPIA) contract, providing leadership, technical guidance, and quality oversight to ensure accurate and timely completion of eligibility review activities.

Analytica has been recognized by Inc. Magazine as one of the fastest-growing 250 businesses in the US for 3 years. We work with U.S. government clients in health, civilian, and national security missions to build better technology products that impact our day-to-day lives. The company offers competitive compensation with opportunities for bonuses, employer-paid health care, training and development funds, and 401k match.    

Responsibilities include:

• Lead Onsite and Virtual Reviews: Direct all eligibility reviews, including oversight of sampled case reviews, staff interviews, and related review activities.
• Coordinate Meetings and Training: Organize and participate in all required team meetings and trainings to prepare for state reviews; ensure team readiness and compliance with review protocols.
• Oversee Reporting Requirements: Assist in the completion of all applicable reporting requirements following reviews, ensuring accuracy, timeliness, and adherence to CMS standards.
• Develop Final Reports: Lead the development of final reports for each completed review in collaboration with other staff, incorporating findings, analysis, and recommendations.
• Create Analytical Tools: Design and implement analytical tools and templates to support review activities and post-review analysis.
• Conduct Independent Analysis: Perform detailed independent analysis of beneficiary eligibility determinations, including financial eligibility assessments, identity verification, and timeline evaluations. Provide subject matter expertise and guidance to team members as needed.
• Ensure Quality and Consistency: Monitor review processes to ensure consistency across cases and states, providing feedback and coaching to reviewers to maintain high-quality standards.
• Research Policy and Program Developments: Stay current on developments in Medicaid and CHIP eligibility policy and regulations to inform review activities and provide guidance to the team.
• Liaise with Stakeholders: Serve as a point of contact with CMS, state agencies, and internal teams to communicate findings, clarify requirements, and support resolution of issues identified during reviews.

Qualifications

• Bachelor’s degree in public health, healthcare administration, public policy, social work, business, healthcare or a related field. Masters degree in these fields a plus.
• Minimum 7 years of experience in Medicaid and/or CHIP eligibility, program integrity, auditing, or related oversight functions.
• Demonstrated knowledge of Federal and state Medicaid/CHIP eligibility requirements, including application, redetermination, and FMAP claiming rules.
• Experience leading teams or supervising staff, with proven ability to manage complex review activities and ensure quality outcomes.
• Strong analytical skills, including the ability to evaluate financial eligibility data, beneficiary records, and program documentation for accuracy and compliance.
• Excellent written and verbal communication skills, with the ability to prepare reports, present findings, and communicate effectively with CMS, state officials, and internal stakeholders.
• Ability to organize, prioritize, and manage multiple tasks under tight deadlines.
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) and ability to develop analytical tools to support review activities.

 

About Analytica: Analytica is a leading consulting and information technology solutions provider to public sector organizations supporting health, civilian, and national security missions. The company is an award-winning SBA certified 8(a) small business that has been recognized by Inc. Magazine each of the past three years as one of the 250 fastest-growing companies in the U.S. Analytica specializes in providing software and systems engineering, information management, analytics & visualization, agile project management, and management consulting services. The company is appra