Medicaid Compliance Subject Matter Expert (SME)

BerryDunn•Remote,

19h•$95,000 - $130,000•Hybrid

About The Position

BerryDunn 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 BerryDunn project teams, State stakeholders, 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.

Requirements

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.

Nice To Haves

Experience supporting Medicaid, health and human services, Program Integrity, TPL, PERM, audit response, FWA, or corrective action initiatives.
Experience working with Vendor-managed Medicaid systems, or similar public sector technology environments.
Experience supporting release readiness, system enhancement, testing, implementation, validation, operational readiness, or post-implementation follow-up.
Experience coordinating with cross-functional project teams, compliance SMEs, payment integrity SMEs, audit and TPL SMEs, training, operations, policy, vendor partners, and project leadership.
Minimum three (3) years of experience in a comparable Medicaid compliance, program integrity, audit, or consulting role preferred.

Responsibilities

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.