Senior Medicaid Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct analysis of Medicaid claims, encounters, provider data, member information, eligibility, financial, and program data to uncover trends, anomalies, risks, indicators of improper payments, and areas for improvement.

• Assist in ensuring Medicaid program integrity, addressing fraud, waste, and abuse, and supporting payment integrity and third-party liability initiatives through policy and operational analysis, research, monitoring, and decision support.

• Assess Medicaid policies, business rules, operations, workflows, and controls to identify deficiencies, root causes, compliance issues, and opportunities for enhancement.

• Create and interpret performance metrics, reports, dashboards, analytical summaries, and decision-support materials.

• Convert complex data, policy, compliance, and operational insights into findings, risks, recommendations, and implementation strategies.

• Lead comprehensive analyses and project workstreams.

• Collaborate with specialists in program integrity, forensic analysis, payment integrity, compliance, third-party liability, policy, data, and operations.

• Engage directly with clients, project leadership, and stakeholders.

• Mentor junior team members.

• Contribute to proposals and the ongoing expansion of BerryDunn’s Medicaid and public-sector healthcare expertise.

⛳️ Requirements

• A master’s degree in public health, health policy, health administration, public policy, business administration, data analytics, economics, information systems, or a related discipline; the posting indicates a preference for a master’s degree.

• A minimum of five years of progressively responsible experience in supporting Medicaid, health and human services, healthcare program integrity, payment integrity, public-sector healthcare operations, healthcare analytics, or related consulting.

• Familiarity with the structure and operations of Medicaid programs, including claims and encounters, eligibility and enrollment, provider data, managed care, reimbursement, compliance, or other essential Medicaid functions.

• Experience in analyzing Medicaid or other healthcare program data to identify trends, anomalies, risks, root causes, financial implications, or prospects for operational and program improvement.

• Proficient in using Excel, SQL, SAS, Power BI, Tableau, or similar data analysis, reporting, or visualization tools.

• Capability to synthesize complex data, policy, compliance, operational, and stakeholder information into concise findings, recommendations, and decision-support documents.

• Excellent analytical, problem-solving, writing, documentation, and communication abilities.

• Ability to independently lead intricate analyses while collaborating across multidisciplinary teams.

• Competence in managing sensitive Medicaid, provider, member, operational, personally identifiable, and protected health information in compliance with privacy, security, confidentiality, and HIPAA standards.

• Preferred experience in Medicaid program integrity, fraud, waste, abuse, payment integrity, third-party liability, PERM, claims review or audit, compliance monitoring, recoveries, or cost-avoidance initiatives.

• Preferred experience with Medicaid claims, encounters, provider, member, eligibility, third-party liability, MMIS/MES, data warehouse, managed care, or vendor-managed systems and data.

• Preferred consulting or client-facing experience, including leading workstreams, managing stakeholder relationships, mentoring junior professionals, and contributing to proposal or business development efforts.

• Must be available during Hawaii Standard Time working hours.

• May involve occasional travel within Hawaiʻi and the continental United States.

🏝️ Benefits

• Eligibility for discretionary annual bonuses based on both company and individual performance.

• Benefits that promote physical, mental, career, social, and financial well-being.

• Flexible work arrangements, including fully onsite, hybrid, or remote options.

• Reasonable accommodations for the application process, interviews, and essential job functions.

• A culture that emphasizes learning, development, and overall well-being.