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The Role:
- Support development of recommendations for cost avoidance, recovery, and improved program controls based on claims analytics and program integrity findings.
- Research and apply Medicaid payment policy, program integrity requirements, and audit findings to support defensible review conclusions.
- Document and report claims audit findings, risk indicators, and recommended actions clearly for management, clients, vendors, and project leadership.
What You'll Bring:
- Strong leadership, communication, facilitation, organization, and attention to detail.
- Knowledge of Medicaid program integrity, fraud prevention, provider oversight, claims review, and compliance monitoring.
- Experience with quality assurance, corrective action tracking, Jira, SharePoint, Excel, Power BI, SQL, and AI tools.
Work Location & Travel:
- Flexible work location including fully onsite, hybrid, or remote arrangements, with availability during Hawaii Standard Time hours.
- Travel approximately 30%–50% of the time, including travel to Hawaiʻi for onsite client meetings and project needs.
BerryDunn
BerryDunn is a professional services firm providing tax, advisory, consulting, and attest services to businesses, nonprofits, and government agencies. It is a client-centered, people-first firm focused on learning, development, and well-being.