Senior Medicaid Analyst

🕒 5 dias atrás

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $80.000 - $120.000 / ano

⏰ Tempo Integral

🟠 Sênior

🧐 Analista

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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

• Analyze Medicaid claims, encounter, provider, member, eligibility, financial, and program data to identify trends, anomalies, risks, improper payment indicators, and improvement opportunities • Support Medicaid program integrity, fraud, waste, and abuse, payment integrity, and third-party liability initiatives through policy and operational analysis, research, monitoring, and decision support • Evaluate Medicaid policies, business rules, operations, workflows, and controls to identify gaps, root causes, compliance concerns, and improvements • Develop and interpret performance measures, reports, dashboards, analytical summaries, and decision-support products • Translate complex data, policy, compliance, and operational information into findings, risks, recommendations, and implementation considerations • Lead substantive analyses and workstreams • Collaborate with program integrity, forensic, payment integrity, compliance, TPL, policy, data, and operational specialists • Work directly with client and project leadership and stakeholders • Mentor junior staff • Contribute to proposals and the continued growth of BerryDunn’s Medicaid and public-sector healthcare capabilities

🎯 Requisitos

• Master’s degree in public health, health policy, health administration, public policy, business administration, data analytics, economics, information systems, or a related field; the posting also states “Master’s degree preferred” • 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 • Knowledge of Medicaid program structure and operations, including claims and encounters, eligibility and enrollment, provider data, managed care, reimbursement, compliance, or other core Medicaid functions • 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 Excel, SQL, SAS, Power BI, Tableau, or comparable data analysis, reporting, or visualization technologies • 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 • Ability to independently lead complex analyses while collaborating across multidisciplinary teams • Ability to handle sensitive Medicaid, provider, member, operational, personally identifiable, and protected health information in accordance with privacy, security, confidentiality, and HIPAA requirements • Preferred experience with Medicaid program integrity, fraud, waste, and abuse, payment integrity, third-party liability, PERM, claims review or audit, compliance monitoring, recoveries, or cost-avoidance initiatives • Preferred experience with Medicaid claims, encounter, provider, member, eligibility, TPL, MMIS/MES, data warehouse, managed care, or vendor-managed systems and data • Preferred consulting or client-facing experience, including leading workstreams, managing stakeholder relationships, mentoring junior professionals, and contributing to proposal or business development • Availability during Hawaii Standard Time working hours • May require periodic travel within Hawaiʻi and the continental United States

🏖️ Benefícios

• Discretionary annual bonus eligibility based on company and personal performance • Benefits supporting physical, mental, career, social, and financial well-being • Flexible work location, including fully onsite, hybrid, or remote arrangements • Reasonable accommodation for the application, interview, and essential job functions • Learning, development, and well-being culture