Senior Consultant – Medicaid Program Integrity

🕒 Agosto 6

🌺 Hawaii – Remoto

🌺 Hawaii – Remote

💵 $85.000 - $100.000 / ano

⏰ Tempo Integral

🟠 Sênior

💼 Consultor

👻 Score fantasma 11%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

Candidatar-se

Encontrar Vagas Remotas Similares

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

• Conduct detailed reviews of Medicaid claims and provider, member, eligibility, financial, and operational data • Identify, document, and escalate potential fraud, waste, abuse, improper payments, compliance issues, and operational risks • Review claims for accuracy, compliance, reasonableness, policy alignment, regulations, program requirements, and coding standards • Support reviews of provider management, member services, financial management, and TPL operational data • Prepare case summaries, findings, recommendations, workpapers, and supporting audit and investigative documentation • Research, interpret, and apply Medicaid policies, program integrity requirements, and regulations • Assist with controls, monitoring approaches, review protocols, audit tools, documentation standards, and process improvements • Support updates to Medicaid program integrity policies and procedures • Assist with training, knowledge transfer, and technical assistance for client staff • Use Jira, SharePoint, Microsoft Office, Teams, Outlook, and related Medicaid or vendor systems for tracking, documentation, coordination, reporting, and follow-through • Support onsite planning, workgroup sessions, client leadership preparation, release activities, and project needs • Collaborate with MQD staff, audit and TPL specialists, data analysts, compliance staff, vendor partners, and cross-functional workstream members

🎯 Requisitos

• Minimum three (3) years of experience conducting Medicaid claims audits, investigations, and/or compliance reviews • Knowledge of Medicaid Program Integrity principles, fraud, waste and abuse, provider oversight, payment integrity, TPL, claims audit, or cost avoidance concepts • Experience developing or supporting audit findings, corrective action plans, executive-ready reporting, analytical summaries, methodology documentation, quality checks, or recurring performance reports • Strong analytical, documentation, quality assurance, and stakeholder coordination skills • Experience using SharePoint, Microsoft Teams, Outlook, Excel, or comparable tools • Ability to research and analyze Medicaid policies, claims, provider oversight, payment integrity, and program integrity requirements • Ability to handle sensitive program, operational, provider, member, client, PII/PHI, and HIPAA-related information in accordance with confidentiality and data-security expectations • Availability during Hawaii Standard Time working hours • Ability to travel approximately 30%–50% of the time, including travel to Hawaiʻi • Preferred experience with Medicaid fraud risk assessments, TPL, PERM, payment integrity, and public-sector health-program analytics • Preferred experience reviewing Medicaid medical, dental, behavioral health, and pharmacy claims • Preferred experience coordinating with client stakeholders, vendor partners, project leadership, and cross-functional workstreams • Relevant certifications such as CPC, CHC, CPMA, CFE, CIA, or equivalent are preferred • Preferred experience with Jira, SQL, Power BI, Tableau, or comparable analytics and dashboarding tools

🏖️ Benefícios

• Flexible work location, including fully onsite, hybrid, or remote arrangements • Benefits supporting physical, mental, career, social, and financial well-being • Reasonable accommodation for the application, interview, and job-performance process • Learning, development, and well-being focus • Equal employment opportunity workplace

📊 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