Subject Matter Expert Medicaid Program Integrity, Policy, Systems, and Claims Audits

Medicaid Practice Group Consultant

BerryDunn's Medicaid Practice Group, with headquarters in Portland, Maine, focuses nationally on serving the organizational, program, information technology, and management needs of State Medicaid agencies. We have worked with hundreds of government agencies throughout the United States.

BerryDunn is seeking an individual with subject matter expertise in Medicaid program integrity policy, Medicaid enterprise systems, and claims audits to assist clients with prevention and detection of fraud, waste, and abuse. This individual will be responsible for assisting with the interpretation and application of Medicaid policy, supporting Medicaid agencies with system implementations and upgrades, and conducting Medicaid medical, dental, behavioral health, and pharmacy claims audits.

Travel Expectation : Up to 50% travel to client sites nationwide.

You Will

• Research Medicaid policies and regulations.
• Advise and assist clients in translating Medicaid policy and program needs into system requirements and change requests, ensuring the State's program, policy, and business objectives are accurately captured using industry-standard language.
• Provide frequent, clear, and consistent communication to the client, team members, and vendors.
• Establish and monitor Medicaid program integrity objectives, and key performance indicators (KPIs).
• Ensure the Medicaid program integrity policies and procedures meet federal and state policies and grants compliance.
• Develop or update policies and procedures related to Medicaid program integrity.
• Develop corrective action plans to solve program problems.
• Analyze Medicaid program integrity reports.
• Assist in the development and train the agency on program requirements.
• Serve as a senior systems advisor with a strong understanding of the system implementations.
• Review and audit Medicaid claims for accuracy, legality, and reasonableness.
• Make accurate and informed recommendations on claims based on Medicaid policies and regulations and claims data.
• Document and report audit findings to management.
• Stay up-to-date with changes in Medicaid regulations and industry trends.
• Medicaid systems research and analysis, including but not limited to, member benefit groups, billing codes, system configuration, service limits, system requirements, and electronic billing standards.
• Provide quality assurance reviews of work completed by peers.

You Have

Preferred Qualifications / Experience :

Compensation Details

The base salary range targeted for this role is $120,000 - $140,000. This salary range represents BerryDunn's good faith and reasonable estimate of the range of possible compensation at the time of posting. If an applicant possesses experience, education, or other qualifications more than the minimum requirements for this posting, that applicant is encouraged to apply, and a final salary range may then be based on those additional qualifications; compensation decisions are dependent on the facts and circumstances of each case. The salary of the finalist selected for this role will be based on a variety of factors, including but not limited to, years of experience, depth of experience, seniority, merit, education, training, amount of travel, and other relevant business considerations.