Program Integrity Lead

🕒 Julho 25

Candidatar-se

Encontrar Vagas Remotas Similares

Configurar Alerta de Email para Novas Vagas

📊 Verifique sua pontuação de currículo para esta vaga

Melhore suas chances de conseguir uma entrevista verificando sua pontuação de currículo antes de se candidatar.

Enviar Currículo

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

• Serve as a workstream lead for Program Integrity, audit, policy, process, and systems-related activities. • Lead Medicaid program integrity activities, including fraud, waste, and abuse prevention; provider oversight; compliance monitoring; risk assessment; recovery efforts; and external audit coordination. • Lead the stand-up and stabilization of Program Integrity unit functions, including foundational processes, operating rhythms, documentation, roles, decision points, and quality controls. • Build practical structure and rigor for Program Integrity operations, including repeatable workflows, reporting routines, escalation pathways, audit processes, corrective action tracking, and performance monitoring. • Review and audit Medicaid medical, dental, behavioral health, and pharmacy claims for accuracy, legality, reasonableness, and alignment with Medicaid policies, regulations, billing requirements, and claims data. • Interpret and apply Medicaid policy, federal and state requirements, and applicable code of federal regulations to support compliant program operations. • Establish and monitor program integrity objectives, key performance indicators (KPIs), corrective action plans, and reporting processes. • Analyze claims data, audit results, program integrity reports, recovery information, and related documentation to identify risks, trends, findings, and improvement opportunities. • Develop or update policies, procedures, requirements, guidance, recommendations, training materials, and related program integrity documentation. • Partner with MQD leadership and staff to support adoption of new Program Integrity processes, tools, expectations, and ways of working. • Develop training, guidance, job aids, and transition materials to help MQD staff operate and sustain Program Integrity processes over time. • Support knowledge transfer and handoff planning so Program Integrity responsibilities, documentation, tools, and operating practices can transition to MQD ownership at the appropriate time . • Coordinate priorities, assignments, action items, risks, blockers, dependencies, and follow-up activities across stakeholders, BerryDunn team members, vendor partners, and project leadership. • Lead or co-lead workstream meetings, workgroups, planning sessions, and internal alignment discussions to support timely decisions, clear communication, and consistent follow-through. • Maintain accurate workstream information in Jira, including tasks, action items, blockers, milestones, status notes, due dates, dependencies, priorities, and reporting updates. • Support weekly and monthly project reporting, closeout materials, leadership updates, and client-facing status information. • Review workstream documents, meeting notes, deliverables, recommendations, and client-facing materials for accuracy, consistency, quality, and alignment with project standards. • Use SharePoint/ KnowledgeLink to organize, maintain , and version project documentation consistent with document management expectations. • Escalate risks, blockers, decisions, and support needs early through the appropriate workstream and project management pathways.

🎯 Requisitos

• 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 using Jira or similar project management tools to track action items, status, ownership, deadlines, risks, blockers, dependencies, and deliverables. • Experience coordinating recurring meetings, documenting follow-up items, maintaining workstream alignment, and supporting escalation pathways. • Strong experience with Microsoft applications and artificial intelligence tools. • Prior consulting experience in a national or regional consulting firm, experience working in or with a state Medicaid agency, and/or experience supporting Medicaid program integrity, audit, compliance, or claims operations. • Minimum three (3) years of experience within the last five (5) years in a comparable Medicaid program integrity, compliance, audit, policy, operations, project management, program management, or consulting role. • Bachelor's Degree (BA/BS)—may substitute four years of applicable experience for the degree. • Experience supporting healthcare, government, public sector, or Medicaid initiatives preferred. • Experience managing complex projects involving multiple stakeholders, vendors, workstreams, risks, issues, and deliverables. • Experience standing up, stabilizing, training on, or transitioning new operational units, programs, processes, or business functions.

🏖️ Benefícios

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