Medicaid Payment Integrity SME: Data Analytics & Audits

BerryDunn — Assurance, Tax and Consulting; Kapolei (HI); On-site; USD 95,000 - 120,000; Full time

Job summary

BerryDunn is seeking a Payment Integrity Subject Matter Expert to drive Medicaid program integrity across Hawaiʻi Med-QUEST. You will translate policy, analytics, and audit findings into practical monitoring, dashboarding, and corrective action.

Expected travel up to 25% and close collaboration with cross-functional teams. The role requires data analysis, SQL, and stakeholder coordination, with a focus on identifying improper payments, cost avoidance, and program improvements across medical,

Qualifications

• Experience with Medicaid payment integrity, claims analytics, fraud detection, program integrity, risk assessment, improper payment prevention, recovery, TPL, claims audit, external audit coordination.
• Strong data analysis, dashboarding, SQL, visualization, documentation, QA, and stakeholder coordination skills.
• Experience researching Medicaid policies, federal/state requirements, program integrity expectations, claims data, system configuration, billing codes, benefit groups, service limits, and electronic billing standards.
• Experience coordinating across stakeholders, vendor partners, project leadership and cross-functional workstreams in public sector/Medicaid environments preferred.
• Medical claims billing, adjudication, Medicaid operations, revenue/claims audit experience, and ability to recommend based on policy and data.
• Bachelor’s degree preferred; equivalent experience may be considered.
• Experience using Jira, SharePoint, Power BI, Tableau, SQL, Excel, or comparable tools.

Responsibilities

• Develop analytics approaches to identify improper payments, billing anomalies, fraud risk indicators, and cost recovery opportunities.
• Support dashboards, reports, review protocols, and decision-support products for payment integrity and audits.
• Analyze claims, provider, member, utilization, financial, and operational data to identify high-risk patterns and overpayments.
• Collaborate across stakeholders to prioritize review areas, validate findings, and coordinate follow-up.
• Develop data-driven methodologies and monitoring approaches for consistent payment integrity reviews.
• Advise on system requirements, change requests, and process updates based on analytics and findings.
• Establish program integrity objectives, KPIs, and reporting for ongoing improvement.
• Research and apply Medicaid policy, audit findings, and requirements to support defensible conclusions.
• Document and report audit findings, observations, risks, and actions clearly for management and stakeholders.
• Develop or update procedures, templates, and training materials for client staff and project teams.
• Provide QA reviews of peers’ work and support knowledge transfer.

Skills

Medicaid payment integrity

Data analysis

Dashboarding

SQL

Stakeholder coordination

Documentation/QA

Cost avoidance initiatives

Education

Bachelor’s degree preferred

Tools

Power BI

Tableau

Excel

SQL

Jira

SharePoint

Microsoft Teams/Outlook

Job description

BerryDunn is seeking a Payment Integrity Subject Matter Expert to drive Medicaid program integrity across Hawaiʻi Med-QUEST. You will translate policy, analytics, and audit findings into practical monitoring, dashboarding, and corrective action.

Expected travel up to 25% and close collaboration with cross-functional teams. The role requires data analysis, SQL, and stakeholder coordination, with a focus on identifying improper payments, cost avoidance, and program improvements across medical,