Source Job

• Lead and support Medicaid Enterprise System initiatives, including system modernization, vendor oversight, and program advisory for U.S. territory and state agencies.
• Manage complex multi-stakeholder environments, including government entities, system integrators, and federal partners, ensuring delivery quality and stakeholder alignment.
• Provide subject matter expertise in Medicaid domains such as eligibility, enrollment, claims, and financial management, and contribute to key deliverables like ConOps and APDs.

BerryDunn is a client-centered, people-first professional services firm providing tax, advisory, and consulting services to businesses, nonprofits, and government agencies. Since 1974, they have grown to serve clients throughout the US and its territories, led by CEO Sarah Belliveau and recognized for their inclusive workplace culture and focus on learning and well-being.

• Lead delivery of project-level initiatives or major workstreams within MES programs, including planning, execution, and monitoring of scope, schedule, and deliverables.
• Serve as a primary day-to-day client interface for assigned projects or workstreams, ensuring clear communication and alignment with client stakeholders.
• Coordinate across vendors, system integrators, and internal teams to support effective execution in multi-stakeholder environments.

BerryDunn is a client-centered, people-first professional services firm providing tax, advisory, and consulting services to businesses, nonprofits, and government agencies throughout the US and its territories. The firm has been recognized for creating a diverse and inclusive workplace culture and focuses on learning, development, and well-being.

• Administer fraud, waste, and abuse (FWA) duties, including investigations, audits, and corrective actions.
• Prepare reports, correspondence, and data analysis for internal and external stakeholders.
• Assist in policy development, training, and regulatory compliance for FWA programs.

CareOregon is a nonprofit, mission-driven health plan focused on providing care to low-income Oregonians. With around 1,000 employees, it fosters a culture of equity, diversity, and inclusion, and offers comprehensive benefits.

• Lead one or more client policy initiatives with a team, including policy analysis, client communications, and project tracking.
• Drive your development through an annual growth process in partnership with your supervisor and the learning and development team.
• Participate in new business development through research, proposal content, and marketing materials.

BerryDunn is a professional services firm that has helped businesses, nonprofits, and government agencies since 1974. The firm is client-centered and people-first, with a focus on learning, development, and well-being, and has been recognized for its diverse and inclusive workplace culture.

• Oversee specialized teams supporting revenue integrity ROI activities, ensuring compliance with policies and timely completion.
• Act as liaison between MRO and client audit and PFS leaders, managing workflow and client relationships.
• Manage labor and expenditures to budget, and conduct performance reviews for direct reports and area managers.

MRO is the industry leader in Release of Information (ROI) and Health Information Management (HIM) services, partnering with hospitals and health systems nationwide. The company emphasizes compliance, operational excellence, and client-focused service.

• Own the end-to-end retailer onboarding process, from contract through go-live, coordinating with engineering and customer success.
• Manage weekly scan data submission health, publish dashboards, and ensure timely issue resolution with retailers and CPG partners.
• Serve as primary contact for Altria and RJR, handling compliance, issue remediation, and cross-functional coordination.

PAR Technology Corporation is a leader in restaurant technology, providing software and hardware solutions to over 100,000 restaurants in more than 110 countries. The company embraces a 'Better Together' ethos, offering Unified Customer Experience solutions.

• Manage the end-to-end audit process for charity: water grants, ensuring timely completion and follow-up on findings.
• Conduct compliance reviews of partner documentation, identifying gaps and recommending follow-up actions.
• Coordinate misconduct case intake, documentation, risk assessment, and action plan drafting with the Grant team.

charity: water is a registered nonprofit on a mission to bring clean, safe drinking water to people in need around the world. The organization works with trusted local partners across over 20 countries in Africa and Asia, inspiring giving and ensuring every dollar is maximized for sustainable water solutions.

• Lead payment integrity strategy and execution, including pre- and post-payment reviews, fraud prevention, and recovery efforts.
• Build and manage high-performing multi-vendor portfolios, enforcing SLAs and optimizing contingency fee structures.
• Partner with cross-functional teams to continuously improve claims payment outcomes and drive plan affordability.

Gravie creates health benefits that actually benefit small and midsize businesses and their employees. They are well-capitalized with a unique, non-hierarchical culture that values diversity and high performance.

• Coordinate compliance and accountability systems across MAP's global medicine access operations, maintaining review processes and documentation.
• Track corrective actions, monitor operational metrics, and support organizational readiness for audits and external assessments.
• Collaborate cross-functionally with Programs, Finance, HR, and other teams to strengthen consistency and transparency in compliance processes.

MAP International is a global health nonprofit that provides essential medicines and health supplies to those in need. The organization operates with a distributed team across multiple functions, emphasizing a culture of compliance, accountability, and operational integrity.

• Own HIPAA-compliant source-of-truth artifacts governing Medicare claims business rules.
• Validate changes internally and communicate updates to external CMS stakeholders.
• Bridge product and engineering by translating policy needs into clear requirements.

Nava is a consultancy and public benefit corporation working to make government services simple and effective. Since 2015, they have helped federal, state, and local agencies solve technology modernization challenges, and they are a remote-first team with a collaborative culture.

• Support the Associate Director in managing day-to-day operations of the External Audit Program, ensuring alignment with program goals and regulatory timelines.
• Serve as a versatile operational resource across workstreams, identifying process improvements and implementing changes to enhance scalability, transparency, and quality.
• Communicate updates, risks, and recommendations clearly to cross-functional stakeholders, and support AI-native monitoring of program-wide KPIs.

Devoted Health is on a mission to improve the health and well-being of older Americans through an integrated care platform combining data and AI with clinical and service experiences. The company is an equal opportunity employer that values diversity and collaboration, with a team dedicated to a supportive work environment.

• Plan, develop, and direct all aspects of onshore and offshore BPaaS activities to ensure operational efficiency and customer success.
• Establish operational objectives, policies, and procedures in compliance with contracts and regulations, and develop strategies to achieve key performance measures.
• Provide executive-level briefings to senior leadership and build collaborative relationships with client leadership to drive continuous improvement.

UST HealthProof is on a mission to reshape healthcare insurance by reducing administrative costs and building better healthcare experiences for health plans and their members. The company is run by leaders with strong health plan and technology backgrounds, fostering a supportive, start-up-like environment that nurtures individual growth.

• Lead advanced data analysis and trend analysis to proactively assess compliance risks and enhance monitoring mechanisms.
• Develop comprehensive compliance dashboards and automated reporting systems for real-time insights into compliance performance.
• Drive predictive modeling initiatives and cross-departmental collaboration to optimize compliance operations and resource allocation.

Aledade is a public benefit corporation that empowers independent primary care practices to thrive in value-based care. As the largest network of independent primary care in the country, Aledade offers a collaborative, inclusive, and remote-first culture.

• You will support the delivery of services to clients on time, within scope, and within budget, including creating written deliverables.
• You will participate in meetings and interviews with client stakeholders to document needs and challenges.
• You will work effectively as a team player on multiple client projects and support team operations.

BerryDunn is a leading national professional services firm providing assurance, tax, and consulting services to businesses, nonprofits, and government agencies. The firm has been recognized for its diverse and inclusive workplace culture and focus on learning, development, and well-being.

• Provide local oversight of the 340B program and ensure compliance with federal regulations.
• Manage split-billing software maintenance and conduct self-audits to maintain audit readiness.
• Serve as the primary liaison for all 340B-related matters and coordinate external audits.

Baptist Health is a full-spectrum health system dedicated to improving the health of the communities it serves. It employs more than 24,000 people across Kentucky and surrounding states, with 10 hospitals and numerous points of care.

• Lead the organization's strategic response to federal Medicaid changes, including becoming a Qualified Entity in eligible states.
• Oversee implementation of SOAR training and medical frailty documentation protocols across all operating states.
• Develop tracking systems and evaluation frameworks for coverage retention, redetermination, and SSDI/SSI enrollment outcomes.

GRT provides substance use disorder treatment and support services, including Medicaid enrollment assistance and recovery programs. The company operates in multiple states with a remote workforce, fostering a culture of collaboration and urgency in addressing complex healthcare challenges.

• Provide clinical leadership and medical oversight for audit programs involving governmental and commercial payer claims.
• Evaluate medical necessity, level of care, coding accuracy, and documentation sufficiency using payer policies and clinical standards.
• Support audit methodologies, clinical validation frameworks, and quality assurance to ensure regulatory alignment and defensibility.

Machinify is a leading healthcare intelligence company delivering value, transparency, and efficiency to health plan clients. Deployed by over 85 health plans representing more than 270 million lives, they bring an AI-powered platform alongside best-in-class expertise.

• Audits claims, customer service inquiries, member and group enrollment activities to validate Plan performance.
• Supports internal audit and special investigations as needed.
• Analyzes performance guarantee accounts and participates in external client audit requests.

Capital Blue Cross is a health insurance company providing coverage and services. They have been voted one of the 'Best Places to Work in PA' and foster a flexible, supportive culture with emphasis on employee well-being.

• Serve as the primary operational subject matter expert for payment integrity methodologies, audit programs, and product requirements.
• Translate payer pain points, contract language, and audit policy into product capabilities and scalable AI solutions.
• Partner with engineering, product, clinical, and customer success teams to define audit logic and improve product accuracy.

Abacus Insights transforms healthcare data for health plans, breaking down silos to create trusted data foundations that improve outcomes and reduce waste. Backed by $100M from top investors, the company has a bold, collaborative culture focused on innovation and using AI to drive efficiency.

• Coordinates and administers privacy and compliance programs to ensure adherence to regulatory requirements.
• Partners with internal teams to interpret requirements, implement compliant solutions, and monitor activities.
• Develops policies, tracks corrective actions, and supports audits to maintain program effectiveness.

Capital Blue Cross is a health insurance company that improves the health and well-being of members and communities. It is an independent licensee of the Blue Cross Blue Shield Association and has been voted a 'Best Place to Work in PA' by employees.