Note: The job is a remote job and is open to candidates in USA. BerryDunn is a professional services firm supporting government agencies and other organizations through consulting, analytics, and advisory services. The Senior Medicaid Analyst will analyze Medicaid and healthcare data, evaluate policies and operations, and support Hawaiʻi Med-QUEST program integrity initiatives involving fraud, waste and abuse, payment integrity, third-party liability, compliance, and operational improvement. The role will also lead complex analyses, develop decision-support products, collaborate with multidisciplinary teams, and mentor junior staff.
Responsibilities
- Analyze Medicaid claims, encounter, provider, member, eligibility, financial, and program data to identify trends, anomalies, risks, improper payment indicators, and opportunities for program improvement
- Support Medicaid program integrity, fraud, waste, and abuse, payment integrity, and third-party liability initiatives through policy and operational analysis, provider and member research, trend monitoring, and assessment of financial and program impacts
- Evaluate Medicaid policies, business rules, program operations, workflows, and controls to identify gaps, root causes, compliance concerns, and opportunities to strengthen program effectiveness and accountability
- Develop and interpret performance measures, reports, dashboards, analytical summaries, and other decision-support products for Medicaid leadership, program integrity teams, and project stakeholders
- Translate complex data, policy, compliance, and operational information into clear findings, risks, recommendations, and implementation considerations for technical and non-technical audiences
- Lead substantive analyses and workstreams; collaborate with program integrity, forensic, payment integrity, compliance, TPL, policy, data, and operational specialists; mentor junior staff; and contribute to proposals and the continued growth of BerryDunn’s Medicaid services
Skills
- * Master's degree in public health, health policy, health administration, public policy, business administration, data analytics, economics, information systems, or a related field
- * Five or more years of progressively responsible experience supporting Medicaid, health and human services, healthcare program integrity, payment integrity, public-sector healthcare operations, healthcare analytics, or related consulting work
- * Demonstrated knowledge of Medicaid program structure and operations, including experience with claims and encounters, eligibility and enrollment, provider data, managed care, reimbursement, compliance, or other core Medicaid functions
- * Demonstrated experience analyzing Medicaid or other healthcare program data to identify trends, anomalies, risks, root causes, financial impacts, or opportunities for operational and program improvement
- * Experience using data analysis, reporting, or visualization tools such as Excel, SQL, SAS, Power BI, Tableau, or comparable technologies to analyze and communicate healthcare information
- * Ability to synthesize complex data, policy, compliance, operational, and stakeholder information into clear findings, recommendations, and decision-support materials
- * Strong analytical, problem-solving, writing, documentation, and communication skills, including the ability to independently lead complex analyses while collaborating effectively across multidisciplinary teams
- * Ability to work appropriately with sensitive Medicaid, provider, member, operational, personally identifiable information, and protected health information and follow applicable privacy, security, confidentiality, and HIPAA requirements
- * The preferred location is Hawaiʻi or the U.S. West Coast
- * The role requires availability during Hawaii Standard Time (HST) working hours and may require periodic travel within Hawaiʻi and the continental United States based on project needs
- * Master's degree preferred
- * Experience supporting Medicaid program integrity, fraud, waste, and abuse, payment integrity, third-party liability, PERM, claims review or audit, compliance monitoring, recoveries, or cost-avoidance initiatives
- * Experience with Medicaid claims, encounter, provider, member, eligibility, TPL, MMIS/MES, data warehouse, managed care, or vendor-managed systems and data
- * Experience identifying provider or member patterns, improper payment indicators, operational risks, compliance issues, or opportunities for improved program controls using Medicaid or healthcare data
- * Experience in consulting or another client-facing environment, including leading workstreams, managing stakeholder relationships, mentoring junior professionals, and contributing to proposal development or business development
Benefits
- This position may also be eligible for a discretionary annual bonus based on factors such as company and personal performance.
- This position offers flexibility in work location, including fully onsite, hybrid, or remote arrangements.
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