Senior Consultant – Medicaid Program Integrity

BerryDunn — Assurance, Tax and Consulting

Medicaid forensic analyst auditing claims and investigating fraud, waste, abuse, and improper payments for BerryDunn’s public-sector clients. Supporting controls, reporting, corrective actions, and program-integrity improvements.

Posted 8/6/2026full-timeRemote • Hawaii • 🇺🇸 United StatesSenior💰 $85,000 - $100,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Medicaid Claims Audits, Fraud Detection, and Compliance Reviews, with strong analytical skills and the ability to handle sensitive information in accordance with HIPAA regulations. Proficient in developing audit findings and recommendations while collaborating with cross-functional teams and stakeholders.

Highest-signal resume keywords

Medicaid Claims AuditsFraud DetectionCompliance ReviewsAnalytical SkillsHIPAA Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medicaid Program IntegrityClaims AuditPayment IntegrityQuality AssuranceAnalytical SummariesCorrective Action PlansDocumentation StandardsResearch and AnalysisData SecurityPerformance Reports

Soft Skills

Stakeholder CoordinationDocumentation SkillsAttention to DetailCollaborationTraining and Knowledge Transfer

Tools & Technologies

JiraSharePointMicrosoft OfficeMicrosoft TeamsOutlookExcelSQLPower BITableauMedicaid Systems

Certifications & Qualifications

CPCCHCCPMACFECIA

Industry Keywords

FraudWasteAbuseProvider OversightTPLPublic-Sector Health-Program AnalyticsMedicaid PoliciesOperational RisksProgram RequirementsCoding Standards

Tech Stack

Tools & technologies

SQLTableau

About the role

Key responsibilities & impact

Conduct detailed reviews of Medicaid claims and provider, member, eligibility, financial, and operational data
Identify, document, and escalate potential fraud, waste, abuse, improper payments, compliance issues, and operational risks
Review claims for accuracy, compliance, reasonableness, policy alignment, regulations, program requirements, and coding standards
Support reviews of provider management, member services, financial management, and TPL operational data
Prepare case summaries, findings, recommendations, workpapers, and supporting audit and investigative documentation
Research, interpret, and apply Medicaid policies, program integrity requirements, and regulations
Assist with controls, monitoring approaches, review protocols, audit tools, documentation standards, and process improvements
Support updates to Medicaid program integrity policies and procedures
Assist with training, knowledge transfer, and technical assistance for client staff
Use Jira, SharePoint, Microsoft Office, Teams, Outlook, and related Medicaid or vendor systems for tracking, documentation, coordination, reporting, and follow-through
Support onsite planning, workgroup sessions, client leadership preparation, release activities, and project needs
Collaborate with MQD staff, audit and TPL specialists, data analysts, compliance staff, vendor partners, and cross-functional workstream members

Requirements

What you’ll need

Minimum three (3) years of experience conducting Medicaid claims audits, investigations, and/or compliance reviews
Knowledge of Medicaid Program Integrity principles, fraud, waste and abuse, provider oversight, payment integrity, TPL, claims audit, or cost avoidance concepts
Experience developing or supporting audit findings, corrective action plans, executive-ready reporting, analytical summaries, methodology documentation, quality checks, or recurring performance reports
Strong analytical, documentation, quality assurance, and stakeholder coordination skills
Experience using SharePoint, Microsoft Teams, Outlook, Excel, or comparable tools
Ability to research and analyze Medicaid policies, claims, provider oversight, payment integrity, and program integrity requirements
Ability to handle sensitive program, operational, provider, member, client, PII/PHI, and HIPAA-related information in accordance with confidentiality and data-security expectations
Availability during Hawaii Standard Time working hours
Ability to travel approximately 30%–50% of the time, including travel to Hawaiʻi
Preferred experience with Medicaid fraud risk assessments, TPL, PERM, payment integrity, and public-sector health-program analytics
Preferred experience reviewing Medicaid medical, dental, behavioral health, and pharmacy claims
Preferred experience coordinating with client stakeholders, vendor partners, project leadership, and cross-functional workstreams
Relevant certifications such as CPC, CHC, CPMA, CFE, CIA, or equivalent are preferred
Preferred experience with Jira, SQL, Power BI, Tableau, or comparable analytics and dashboarding tools

Benefits

Comp & perks

Flexible work location, including fully onsite, hybrid, or remote arrangements
Benefits supporting physical, mental, career, social, and financial well-being
Reasonable accommodation for the application, interview, and job-performance process
Learning, development, and well-being focus
Equal employment opportunity workplace