Medicaid Compliance Subject Matter Expert (SME

Overview

Berry Dunn is seeking a Medicaid Compliance Subject Matter Expert (SME).This position will provide expertise on federal and state Medicaid requirements, compliance monitoring, audit readiness, corrective action planning, risk mitigation, and the operational impacts of Medicaid enterprise systems and related workflows.

In this role, the Medicaid Compliance SME will work closely with cross-functional Berry Dunn project teams, Statestakeholders, Program Integrity staff, audit and TPL subject matter experts, data analysts, vendor partners, and project leadership to interpret requirements, assess risks, document processes, support system and operational improvements, and develop practical recommendations. The SME will help connect Medicaid policy, program operations, business process redesign, issue tracking, training, documentation, and change readiness activities so that project recommendations are actionable, compliant, and aligned our project priorities.

Travel expectations: This role may require travel up to 25% of the year.

• Interpret Medicaid regulatory, Program Integrity, Third-Party Liability (TPL), Payment Error Rate Measurement (PERM), and compliance requirements relevant to the engagement.
• Support compliance assessments, audit readiness activities, and documentation of risks and gaps.
• Develop recommendations, corrective action approaches, and process improvements to address compliance findings.
• Support responses to Centers for Medicare & Medicaid Services (CMS), state, or stakeholder requests related to Medicaid Program Integrity and Fraud, Waste, and Abuse (FWA) activities.
• Support development and refinement of monitoring approaches, review protocols, documentation standards, and repeatable compliance review processes for Program Integrity,FWA, TPL, PERM, audit support, and corrective action activities.
• Translate compliance findings, Medicaid policy interpretations, audit results, operational needs, and stakeholder feedback into practical recommendations for process updates, policy clarification, system considerations, vendor follow-up, training needs, or corrective action planning.
• Support documentation quality, issue escalation, decision tracking, and follow-through for compliance, Program Integrity, audit, TPL, and FWA-related activities across the project.
• Collaborate with policy, program, analytics, forensic, payment integrity, audit, TPL, vendor, and project leadership team members to align findings, prioritize follow-up activities, and coordinate recommendations.
• Review policies, procedures, workflows, and operational materials for compliance considerations.
• Support Medicaid system, policy, and operational improvement efforts by applying program knowledge to workflows, documentation, stakeholder needs, and business process redesign activities.
• Identify and monitor compliance, operational, and system-related risks that may affect Program Integrity, TPL, PERM, FWA, audit support, policy alignment, or related Medicaid activities.
• Assess the impact of federal and state Medicaid policy changes on operations, compliance activities, reporting, documentation, training, and system-supported workflows.
• Support system enhancement, testing, implementation, and validation activities when compliance, program, reporting, or operational requirements intersect with Medicaid system changes.
• Support onsite planning, compliance-related workgroup sessions, operational readiness discussions, and other project activities where Medicaid compliance, policy, or Program Integrity expertise is needed.
• Support knowledge transfer, training, and readiness activities for Medicaid staff, project teams, or stakeholders related to compliance requirements, process changes, system workflows, and program integrity concepts.

• Experience with Medicaid compliance, Program Integrity, TPL, PERM, audit response, or corrective action planning.
• Strong policy interpretation, documentation, and risk assessment skills.
• Experience working across operational, policy, analytical, and leadership stakeholders.

Preferred Qualifications /

Experience:

• Experience supporting Medicaid, health and human services, Program Integrity,…