Medicaid Payment Integrity Analyst (Remote/Hybrid)

BerryDunn — Assurance, Tax and Consulting; California (MO); Hybrid; USD 95,000 - 120,000; Full time

Benefits offered by this job

Flexible work location

Travel opportunities

Job summary

BerryDunn is seeking a Medicaid Program Integrity Analyst to support Hawaiʻi MQD's Third Party Liability unit and program integrity activities. The role involves fraud, waste, and abuse prevention, provider oversight, compliance monitoring, and audits across Medicaid claims, with a focus on dashboards, reporting, and process improvement.

The position offers flexibility in work location (onsite, hybrid, or remote) with preferred sites in Kapolei, Hawaiʻi or the U.S.

Qualifications

• Bachelor’s degree preferred; applicable experience may be considered in lieu of degree.
• Experience using Jira, SharePoint, Microsoft Teams, Outlook, Excel, Power BI, Tableau, SQL, or comparable tools to manage action items, documentation, reporting, follow-up, and project coordination.
• Minimum three (3) years of experience in a comparable analytics, payment integrity, program integrity, claims audit, Medicaid operations, healthcare compliance, or consulting role preferred.

Responsibilities

• Support development of recommendations for cost avoidance, recovery, improved program controls, policy clarification, and process improvement based on claims analytics and program integrity findings.
• Research, interpret, and apply Medicaid payment policy, program integrity requirements, audit findings, federal and state requirements, managed care contract expectations, provider billing guidance, and operational procedures.
• Document and report claims audit findings, payment integrity observations, risk indicators, analytical results, and recommended actions clearly for management and clients.
• Support training, release readiness, go-live support, and knowledge transfer related to payment integrity analytics and review processes.
• Provide quality assurance reviews of work completed by peers, including claims audit documentation and client-facing deliverables.

Skills

Leadership

Communication

Facilitation

Organization

Attention to detail

Medicaid program integrity

Microsoft applications

Education

Bachelor's degree

Tools

Jira

SharePoint

Microsoft Teams

Outlook

Excel

Power BI

Tableau

SQL

Job description

BerryDunn is seeking a Medicaid Program Integrity Analyst to support Hawaiʻi MQD's Third Party Liability unit and program integrity activities. The role involves fraud, waste, and abuse prevention, provider oversight, compliance monitoring, and audits across Medicaid claims, with a focus on dashboards, reporting, and process improvement.

The position offers flexibility in work location (onsite, hybrid, or remote) with preferred sites in Kapolei, Hawaiʻi or the U.S.