Audit Resolution Consultant

Dept of Health and Human Services

HEALTH BENEFITS

Human Services Program Consultant I (NS)

60042904

NC14

The Audit Resolution Consultant supports North Carolina Medicaid by computing erroneous payments of state and federal shares resulting from eligibility errors made by county departments of social services.

The position examines county eligibility error findings across state and federal audits to accurately determine county overpayment amounts and reviews claims data using NCTracks to verify service codes, amounts, and eligibility histories. It coordinates with the Local Government Commission, local Certified Public Accountants, and the Office of the State Auditor to establish functional audit requirements and strengthen audit processes.

The Audit Resolution Consultant operates within the Office of Compliance & Program Integrity and ensures financial accountability by applying statutory requirements under N.C. General Statute 108A‑25.1A. This position contributes to Medicaid program integrity by supporting accurate reconciliation of erroneous benefit issuances and claims payments.



Key Duties Include:
– Compute erroneous Medicaid payment amounts by determining state and federal financial responsibility based on county eligibility errors.

– Examine county eligibility error findings across state and federal audits to identify and calculate county overpayment amounts.

– Review claims payment data in NCTracks to verify service codes, claims amounts, and beneficiary eligibility history.

– Analyze erroneous Medicaid benefit issuance data to determine when payments were made for ineligible individuals, dates, or amounts.

– Coordinate with the Local Government Commission, local CPAs, and the Office of the State Auditor to establish audit requirements and improve service provision.

– Liaise with internal and external stakeholders to support functional audit activities and ensure compliance with statutory requirements.

– Document audit findings and payment calculations to support financial reconciliation processes.

– Support oversight activities required under N.C. General Statute 108A‑25.1A to ensure counties are held financially responsible for erroneous Medicaid issuances.

– Evaluate audit outcomes and identify opportunities to strengthen Medicaid error‑detection and accountability processes.

– Maintain accurate records of audit data, calculations, and correspondence to support program integrity and reporting needs.

Tresha Walker