Medicaid Compliance Subject Matter Expert, SME

🕒 Julho 25

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $95.000 - $130.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

🚔 Conformidade

👻 Score fantasma 8%

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BerryDunn — Assurance, Tax and Consulting

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 1974

🏥 Saúde

🛡️ Seguros

⚖️ Jurídico

Healthcare • Insurance • Legal

BerryDunn é uma firma premiada de contabilidade e consultoria com 50 anos de história dedicada a fornecer serviços excepcionais em auditoria, impostos e consultoria. A empresa foca em formar parcerias próximas com os clientes para entregar soluções personalizadas que geram resultados significativos. Suas equipes de especialistas atuam em vários setores, ajudando entidades públicas e privadas a otimizar finanças, reduzir riscos e melhorar processos de negócios com um compromisso com o sucesso do cliente.

Descrição

• Interpret Medicaid regulatory, Program Integrity, Third-Party Liability (TPL), Payment Error Rate Measurement (PERM), and compliance requirements relevant to the engagement. • Support compliance assessments, audit readiness activities, and documentation of risks and gaps. • Develop recommendations, corrective action approaches, and process improvements to address compliance findings. • Support responses to Centers for Medicare & Medicaid Services (CMS), state, or stakeholder requests related to Medicaid Program Integrity and Fraud, Waste, and Abuse (FWA) activities. • Support development and refinement of monitoring approaches, review protocols, documentation standards, and repeatable compliance review processes for Program Integrity, FWA, TPL, PERM, audit support, and corrective action activities. • Translate compliance findings, Medicaid policy interpretations, audit results, operational needs, and stakeholder feedback into practical recommendations for process updates, policy clarification, system considerations, vendor follow-up, training needs, or corrective action planning. • Support documentation quality, issue escalation, decision tracking, and follow-through for compliance, Program Integrity, audit, TPL, and FWA-related activities across the project. • Collaborate with policy, program, analytics, forensic, payment integrity, audit, TPL, vendor, and project leadership team members to align findings, prioritize follow-up activities, and coordinate recommendations. • Review policies, procedures, workflows, and operational materials for compliance considerations. • Support Medicaid system, policy, and operational improvement efforts by applying program knowledge to workflows, documentation, stakeholder needs, and business process redesign activities. • Identify and monitor compliance, operational, and system-related risks that may affect Program Integrity, TPL, PERM, FWA, audit support, policy alignment, or related Medicaid activities. • Assess the impact of federal and state Medicaid policy changes on operations, compliance activities, reporting, documentation, training, and system-supported workflows. • Support system enhancement, testing, implementation, and validation activities when compliance, program, reporting, or operational requirements intersect with Medicaid system changes. • Support onsite planning, compliance-related workgroup sessions, operational readiness discussions, and other project activities where Medicaid compliance, policy, or Program Integrity expertise is needed. • Support knowledge transfer, training, and readiness activities for Medicaid staff, project teams, or stakeholders related to compliance requirements, process changes, system workflows, and program integrity concepts.

🎯 Requisitos

• Experience with Medicaid compliance, Program Integrity, TPL, PERM, audit response, or corrective action planning. • Strong policy interpretation, documentation, and risk assessment skills. • Experience working across operational, policy, analytical, and leadership stakeholders. • Preferred Qualifications/Experience: Experience supporting Medicaid, health and human services, Program Integrity, TPL, PERM, audit response, FWA, or corrective action initiatives. • Experience working with Vendor-managed Medicaid systems, or similar public sector technology environments. • Experience supporting release readiness, system enhancement, testing, implementation, validation, operational readiness, or post-implementation follow-up. • Experience coordinating with cross-functional project teams, compliance SMEs, payment integrity SMEs, audit and TPL SMEs, training, operations, policy, vendor partners, and project leadership. • Minimum three (3) years of experience in a comparable Medicaid compliance, program integrity, audit, or consulting role preferred.

🏖️ Benefícios

• Eligible employees have access to benefits that go beyond what’s expected to support their physical, mental, career, social, and financial well-being.