Note: The job is a remote job and is open to candidates in USA. BerryDunn is a professional services firm providing assurance, tax, advisory, and consulting services to businesses, nonprofits, and government agencies. The Medicaid Program Integrity Analyst will support Hawaiʻi Med-QUEST Third Party Liability and program integrity activities, including claims audits, fraud and abuse prevention, compliance monitoring, risk assessment, recovery efforts, reporting, quality assurance, and process improvement.
Responsibilities
- Support development of recommendations for cost avoidance, recovery, improved program controls, policy clarification, process improvement, system edits, vendor follow-up, and corrective action planning based on claims analytics and program integrity findings
- Research, interpret, and apply Medicaid payment policy, program integrity requirements, audit findings, federal and state requirements, managed care contract expectations, provider billing guidance, and operational procedures to support defensible review conclusions and recommendations
- Document and report claims audit findings, payment integrity observations, risk indicators, analytical results, and recommended actions clearly and consistently for management, client stakeholders, vendors, and project leadership
- Support training, technical assistance, workgroup facilitation, release readiness, go-live support, and knowledge transfer related to payment integrity analytics, review processes, dashboard use, documentation expectations, and follow-up procedures
- Provide quality assurance reviews of work completed by peers, including claims audit documentation, analytical findings, review protocols, reports, corrective action supports, and client-facing deliverables
- Use Jira, SharePoint, meeting notes, decision logs, action item trackers, dashboards, and reporting tools to support transparent issue tracking, documentation, coordination, and follow-through across our workstreams
- Support onsite planning, release activities, operational readiness, and related project needs in coordination with project leadership and workstream leads
Skills
- Regardless of location, the role requires availability during Hawaii Standard Time (HST) working hours
- This role requires travel approximately 30%–50% of the time, including travel to Hawaiʻi for onsite client meetings, release activities, training support, go-live readiness, payment integrity workgroup sessions, and related project needs
- Strong leadership, communication, facilitation, organization, and attention to detail
- Knowledge of Medicaid program integrity, fraud, waste, and abuse prevention, provider oversight, claims review, audit support, compliance monitoring, or related public sector healthcare operations
- Knowledge of quality assurance/control procedures, corrective action tracking, and proactive problem management
- Demonstrated ability to work effectively in a team setting and coordinate across multiple stakeholders, including clients, vendors, project leadership, and internal teams
- Experience coordinating recurring meetings, documenting follow-up items, maintaining workstream alignment, and supporting escalation pathways
- Strong experience with Microsoft applications and artificial intelligence tools
- Bachelor's degree preferred; applicable experience may be considered in lieu of degree requirements
- Experience using Jira, SharePoint, Microsoft Teams, Outlook, Excel, Power BI, Tableau, SQL, or comparable tools to manage action items, documentation, reporting, follow-up, and project coordination
- Minimum three (3) years of experience in a comparable analytics, payment integrity, program integrity, claims audit, Medicaid operations, healthcare compliance, or consulting role preferred
- Prior consulting experience in a national or regional consulting firm, health plan, Medicaid agency, program integrity unit, or public sector health and human services environment
- Experience with government agencies, Medicaid program integrity units, fraud risk assessments, internal audits, external audits, claims audit reviews, quality assurance, corrective action planning, or improper payment prevention efforts
- Bachelor's Degree (BA/BS)—may substitute four years of applicable experience for the degree
- Preference may be given to candidates with certifications such as Certified Professional Coder, Certified Fraud Examiner, Certified Professional Medical Auditor, Certified Internal Auditor, or equivalent credentials
Benefits
- This position offers flexibility in work location, including fully onsite, hybrid, or remote arrangements.
- Eligible employees have access to benefits that go beyond what’s expected to support their physical, mental, career, social, and financial well-being.
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