Medicaid Program Integrity Analyst

Berry Dunn 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.

Work location: 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 Coast. Regardless of location, the role requires availability during Hawaii Standard Time (HST) working hours.

Travel expectations: This role requires travel approximately 30%–50% of the time, including travel to Hawaiʻi for onsite client meetings, release activities, training support, go-live readiness, payment integrity workgroup sessions, and related project needs.

• Support development of recommendations for cost avoidance, recovery, improved program controls, policy clarification, process improvement, system edits, vendor follow-up, and corrective action planning based on claims analytics and program integrity findings.
• Research, interpret, and apply Medicaid payment policy, program integrity requirements, audit findings, federal and state requirements, managed care contract expectations, provider billing guidance, and operational procedures to support defensible review conclusions and recommendations.
• Document and report claims audit findings, payment integrity observations, risk indicators, analytical results, and recommended actions clearly and consistently for management, client stakeholders, vendors, and project leadership.
• Support training, technical assistance, workgroup facilitation, release readiness, go-live support, and knowledge transfer related to payment integrity analytics, review processes, dashboard use, documentation expectations, and follow-up procedures.
• Provide quality assurance reviews of work completed by peers, including claims audit documentation, analytical findings, review protocols, reports, corrective action supports, and client-facing deliverables.
• Use Jira, SharePoint, meeting notes, decision logs, action item trackers, dashboards, and reporting tools to support transparent issue tracking, documentation, coordination, and follow-through across our work streams.
• Support onsite planning, release activities, operational readiness, and related project needs in coordination with project leadership and workstream leads.

Use the following key tools and systems:

• 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

• 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…