Senior Medicaid Analyst

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $80k - $120k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

👻 Ghost score 0%

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BerryDunn — Assurance, Tax and Consulting

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1974

🏥 Healthcare

🛡️ Insurance

⚖️ Legal

Healthcare • Insurance • Legal

BerryDunn is an award-winning accounting and consulting firm with a 50-year history dedicated to providing exceptional services in assurance, tax, and consulting. The firm focuses on forming close partnerships with clients to deliver customized solutions that drive meaningful outcomes. Its expert teams work across various sectors, helping public and private entities optimize finances, reduce risks, and improve business processes with a commitment to client success.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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