Audit Resolution Consultant

Agency
Dept of Health and Human Services
Division
HEALTH BENEFITS

Job Classification Title

Human Services Program Consultant I (NS)

Position Number

60042904

Grade

NC14

About Us

The North Carolina Department of Health and Human Services (DHHS) is one of the largest, most complex agencies in the state, and has approximately 17,000 employees. It is responsible for ensuring the health, safety, and well-being of all North Carolinians, providing human service needs for special populations including individuals who are deaf, blind, developmentally disabled, and mentally ill, and helping poor North Carolinians achieve economic independence.

Description of Work

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.

Knowledge Skills and Abilities/Management Preferences

Salary Grade Range: $52,592.00 - $92,036.00

Candidates now meet the minimum qualifications of a position if they meet the minimum education and experience listed on the vacancy announcement.

The Knowledge, Skills, and Abilities (KSAs)/ Management Preferences are not required. Applicants who possess the following skills are preferred:

• Demonstrated experience navigating, evaluating, and analyzing NCFAST system decisions and functionality at an intermediate or higher proficiency level, with at least three years of documented use.
• Track record navigating and evaluating NCTracks (MMIS) system functionality to obtain and interpret service codes, claims amounts, and beneficiary eligibility history, supported by at least three years of experience.
• Documented experience reviewing and interpreting state or county Medicaid eligibility audit findings to support accurate assessment of erroneous payments and overpayment determinations.
• Proven success communicating effectively with internal and external stakeholders to support audit coordination, error resolution, and program integrity activities.
• Established experience analyzing Medicaid claims and eligibility discrepancies using system‑derived data to support accurate computation of erroneous payments and audit outcomes.

Physical Requirements:

Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, or pull or otherwise move objects including the subject’s own body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally, and other sedentary criteria are met.

About the NC Division of Health Benefits:

The Division of Health Benefits (DHB) within NCDHHS is committed to advancing innovative solutions that improve health, promote well-being and foster independence for all North Carolinians. DHB manages and oversees North Carolina Medicaid and other programs that provide access to services and supports for parents, children, seniors, people with intellectual / developmental disabilities, and behavioral health, substance use and traumatic brain injury disorders. With a budget over $27 billion in state and federal funds per fiscal year, DHB ensures that more than 108,000 enrolled providers are reimbursed for delivering covered services to 3.1 million beneficiaries.

Compensation and Benefits:

The State of North Carolina offers excellent comprehensive benefits. Employees can participate in health insurance options, standard and supplemental retirement plans, and the NCFlex program (numerous high-quality, low-cost benefits on a pre-tax basis). Employees also receive paid vacation, sick, and community service leave. In addition, paid parental leave is available to eligible employees.

Application Process

Be sure to complete the application in its entirety. Resumes will not be accepted in lieu of completing this application.

If there are any questions about this posting, please contact Talent Acquisition at talentacquisition@dhhs.nc.gov. Resumes will not be accepted in lieu of completing this application.