Manage forensic review, investigative, and provider audit activities related to Medicaid medical, dental, behavioral health, pharmacy claims, as well as provider, member, financial, audit, TPL, and operational data.
Lead identification, documentation, and escalation of potential fraud, waste, abuse, or non-compliance risks, and review Medicaid claims for accuracy and compliance with policies.
Develop corrective action recommendations and follow-up plans to address identified fraud, waste, abuse, improper payment, compliance, claims, or operational issues.
Lead Medicaid program integrity activities, including fraud, waste, and abuse prevention, provider oversight, compliance monitoring, risk assessment, and audit coordination.
Stand up and stabilize Program Integrity unit functions, including foundational processes, operating rhythms, documentation, and quality controls.
Review and audit Medicaid claims for accuracy, legality, and alignment with policies and regulations.
BerryDunn is a client-centered, people-first professional services firm that helps businesses, nonprofits, and government agencies solve challenges since 1974. The firm is recognized for its inclusive culture, learning, and development focus, led by CEO Sarah Belliveau.
Interpret Medicaid regulatory, Program Integrity, and Third-Party Liability (TPL) requirements to support compliance assessments and audit readiness.
Develop recommendations and corrective action approaches to address compliance findings and support responses to CMS and state agencies.
Collaborate with cross-functional teams to align findings, prioritize follow-up activities, and coordinate recommendations for process improvements.
BerryDunn is a client-centered, people-first professional services firm that has helped businesses, nonprofits, and government agencies since 1974. With a focus on creating a diverse and inclusive workplace, the firm is recognized for its commitment to learning, development, and well-being.
Analyze Medicaid claims, encounter, and program data to identify trends and risks.
Support fraud, waste, and abuse and payment integrity initiatives through analysis and research.
Translate complex findings into clear recommendations for decision-makers.
BerryDunn is a professional services firm providing tax, advisory, and consulting services to businesses, nonprofits, and government agencies. They have been recognized for their inclusive culture and focus on employee well-being.
Lead complex Medicaid initiatives, including policy development, program implementation, and project management for state agencies.
Build relationships with clients, stakeholders, federal partners, and vendors while overseeing junior colleagues.
Deliver client deliverables such as policy recommendations, compliance analysis, and status reports.
BerryDunn is a professional services firm that helps businesses, nonprofits, and government agencies solve challenges through tax, advisory, and consulting services. Since 1974, the firm has been recognized for its diverse and inclusive culture, focus on learning and development, and employee well-being.