Program Integrity Lead

🕒 il y a 27 jours

🇺🇸 États-Unis – Télétravail

💵 $95 000 - $130 000 / an

⏰ Temps Plein

🟠 Senior

👻 Score fantôme 0%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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BerryDunn — Assurance, Tax and Consulting

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501 - 1000 employés

Fondée en 1974

🏥 Santé

🛡️ Assurance

⚖️ Juridique

Healthcare • Insurance • Legal

BerryDunn est un cabinet de comptabilité et de conseil primé, avec une histoire de 50 ans dédiée à fournir des services exceptionnels en assurance, fiscalité et conseil. Le cabinet se concentre sur la formation de partenariats étroits avec ses clients pour offrir des solutions personnalisées qui génèrent des résultats significatifs. Ses équipes d'experts travaillent dans divers secteurs, aidant les entités publiques et privées à optimiser les finances, réduire les risques et améliorer les processus d'affaires avec un engagement envers la réussite des clients.

Description

• 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.

🎯 Exigences

• 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.

🏖️ Avantages

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