Medicaid Program Integrity Analyst

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Requirements Summary

This position offers flexibility in work location, including fully onsite, hybrid, or remote arrangements. The preferred location is Kapolei, Hawaiʻi, or the U.S. West

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OtherAnalyst

BerryDunn is seeking a Medicaid Program Integrity Analyst to support Hawaiʻi Med-QUEST's (MQD) Third Party Liability (TPL) Unit and Program Integrity activities. This role will support Medicaid program integrity activities related to fraud, waste, and abuse prevention; provider oversight; compliance monitoring; risk assessment; external audit coordination; recovery efforts; and Medicaid medical, dental, behavioral health, and pharmacy claims audits.

In this role, the Medicaid Program Integrity Specialist will work closely with Program Integrity staff, TPL experts, forensic specialists, data analysts, compliance SMEs, integrated IT, operations, and policy workstream members, vendor partners, and project leadership to translate Medicaid policy, program needs, claims analytics, and audit findings into practical monitoring approaches, review priorities, system requirements, change requests, operational recommendations, corrective action supports, and process improvement considerations. This individual will support dashboards, reporting, documentation quality, issue escalation, knowledge transfer, quality assurance, and ongoing improvement of payment integrity activities.

Requirements

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Microsoft Excel, and analytics and dashboarding tools for claims analysis, payment integrity monitoring, validation, visualization, and reporting.
Jira for action items, risks, blockers, dependencies, audit follow-up, corrective action tracking, dashboard visibility, release readiness, and project coordination.
SharePoint for project documentation, report templates, payment integrity methodology, review protocols, version control, quality review, training materials, and knowledge management.
Microsoft Teams and Outlook for meeting coordination, stakeholder communication, workgroup facilitation, audit follow-up, training support, and client/vendor collaboration

Prior consulting experience in a national or regional consulting firm, health plan, Medicaid agency, program integrity unit, or public sector health and human services environment.
Experience with government agencies, Medicaid program integrity units, fraud risk assessments, internal audits, external audits, claims audit reviews, quality assurance, corrective action planning, or improper payment prevention efforts.
Bachelor's Degree (BA/BS)—may substitute four years of applicable experience for the degree.
Preference may be given to candidates with certifications such as Certified Professional Coder, Certified Fraud Examiner, Certified Professional Medical Auditor, Certified Internal Auditor, or equivalent credentials.

Strong leadership, communication, facilitation, organization, and attention to detail.
Knowledge of Medicaid program integrity, fraud, waste, and abuse prevention, provider oversight, claims review, audit support, compliance monitoring, or related public sector healthcare operations.
Knowledge of quality assurance/control procedures, corrective action tracking, and proactive problem management.
Demonstrated ability to work effectively in a team setting and coordinate across multiple stakeholders, including clients, vendors, project leadership, and internal teams.
Experience coordinating recurring meetings, documenting follow-up items, maintaining workstream alignment, and supporting escalation pathways.
Strong experience with Microsoft applications and artificial intelligence tools.
Bachelor’s degree preferred; applicable experience may be considered in lieu of degree requirements.
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.

What We Offer

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The base salary range targeted for this role is $95,000-$120,000. This salary range represents BerryDunn’s good faith and reasonable estimate of the range of possible compensation at the time of posting. If an applicant possesses experience, education, or other qualifications more than the minimum requirements for this posting, that applicant is encouraged to apply, and a final salary range may then be based on those additional qualifications; compensation decisions are dependent on the facts and circumstances of each case. The salary of the finalist selected for this role will be based on a variety of factors, including but not limited to, years of experience, depth of experience, seniority, merit, education, training, amount of travel, and other relevant business considerations.

Our people are what make BerryDunn special, and in return we strive to support our employees and help them thrive. Eligible employees have access to benefits that go beyond what’s expected to support their physical, mental, career, social, and financial well-being. Visit our website for a complete list of benefits and a look into our culture: Experience BerryDunn.

We will ensure that individuals are provided reasonable accommodation to participate in the job application or interview process or perform essential job functions. Please contact careers@berrydunn.com to request an accommodation.

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace.

BerryDunn is the brand name under which Berry, Dunn, McNeil & Parker, LLC and BDMP Assurance, LLP, independently owned entities, provide services. Since 1974, BerryDunn has helped businesses, nonprofits, and government agencies throughout the US and its territories solve their greatest challenges. The firm’s tax, advisory, and consulting services are provided by Berry, Dunn, McNeil & Parker, LLC, and its attest services are provided by BDMP Assurance, LLP, a licensed CPA firm.

BerryDunn is a client-centered, people-first professional services firm with a mission to empower the meaningful growth of our people, clients, and communities. The firm has been recognized for its efforts in creating a diverse and inclusive workplace culture, and for its focus on learning, development, and well-being. Learn more at berrydunn.com.

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