Senior Medicaid Analyst

BerryDunn•Remote,

5d•$80,000 - $120,000•Hybrid

About The Position

BerryDunn’s Health Analytics Practice Group (HAPG) is dedicated to supporting decision-makers in state government healthcare agencies, mission-driven organizations, and other public and private sector organizations. Our team brings together deep expertise in health economics, actuarial science, data science, policy analysis, and advanced analytics to help clients address complex questions involving healthcare financing and payment, cost and risk, program performance, and the use of data to inform policy, operational, and strategic decisions. As a Senior Medicaid Analyst, you will apply Medicaid program expertise, healthcare analytics, and policy and operational knowledge to help public-sector clients strengthen program performance, oversight, and accountability. You will analyze Medicaid claims, encounter, provider, member, eligibility, and program data; evaluate program policies and operations; identify risks and opportunities; and translate complex findings into practical recommendations for decision-makers. The position will focus on supporting Hawaiʻi Med-QUEST’s program integrity initiatives, including fraud, waste, and abuse, payment integrity, third-party liability, compliance, and related operational improvement efforts. You will work closely with program integrity leaders, forensic and payment integrity specialists, Medicaid compliance and policy experts, claims analysts, business analysts, vendors, and client stakeholders to identify potential program vulnerabilities, assess operational and financial impacts, and support implementation of effective program improvements. This position offers the opportunity to contribute to high-impact work such as: Analyzing claims, provider, member, and eligibility data to identify unusual patterns, program risks, improper payment indicators, and opportunities for improved oversight. Assessing Medicaid program policies, business processes, and controls to identify operational gaps, root causes, and potential improvements. Supporting fraud, waste, and abuse, payment integrity, and third-party liability initiatives through research, analysis, monitoring, and decision support. Developing reports, performance measures, and recommendations that help Medicaid leaders strengthen program integrity, recover or avoid inappropriate expenditures, and improve program operations. You will collaborate with multidisciplinary teams of Medicaid experts, healthcare analysts, health economists, actuaries, policy and compliance professionals, forensic specialists, data scientists, and other professionals. You will also have opportunities to lead complex analyses and workstreams, work directly with client and project leadership, mentor junior staff, and contribute to the continued growth of BerryDunn’s Medicaid and public-sector healthcare capabilities. Our work environment values critical thinking, intellectual curiosity, mutual respect, and rigorous, evidence-based problem-solving, with an unwavering focus on delivering results that matter to our clients and the communities they serve. This position offers flexibility in work location, including fully onsite, hybrid, or remote arrangements. The preferred location is Hawaiʻi or the U.S. West Coast. BerryDunn’s Hawaiʻi office is located in Kapolei, Oʻahu. The role requires availability during Hawaii Standard Time (HST) working hours and may require periodic travel within Hawaiʻi and the continental United States based on project needs.

Requirements

Master’s degree in public health, health policy, health administration, public policy, business administration, data analytics, economics, information systems, or a related field. Master’s degree preferred.
Five or more years of progressively responsible experience supporting Medicaid, health and human services, healthcare program integrity, payment integrity, public-sector healthcare operations, healthcare analytics, or related consulting work.
Demonstrated knowledge of Medicaid program structure and operations, including experience with claims and encounters, eligibility and enrollment, provider data, managed care, reimbursement, compliance, or other core Medicaid functions.
Demonstrated experience analyzing Medicaid or other healthcare program data to identify trends, anomalies, risks, root causes, financial impacts, or opportunities for operational and program improvement.
Experience using data analysis, reporting, or visualization tools such as Excel, SQL, SAS, Power BI, Tableau, or comparable technologies to analyze and communicate healthcare information.
Ability to synthesize complex data, policy, compliance, operational, and stakeholder information into clear findings, recommendations, and decision-support materials.
Strong analytical, problem-solving, writing, documentation, and communication skills, including the ability to independently lead complex analyses while collaborating effectively across multidisciplinary teams.
Ability to work appropriately with sensitive Medicaid, provider, member, operational, personally identifiable information, and protected health information and follow applicable privacy, security, confidentiality, and HIPAA requirements.

Nice To Haves

Experience supporting Medicaid program integrity, fraud, waste, and abuse, payment integrity, third-party liability, PERM, claims review or audit, compliance monitoring, recoveries, or cost-avoidance initiatives.
Experience with Medicaid claims, encounter, provider, member, eligibility, TPL, MMIS/MES, data warehouse, managed care, or vendor-managed systems and data.
Experience identifying provider or member patterns, improper payment indicators, operational risks, compliance issues, or opportunities for improved program controls using Medicaid or healthcare data.
Experience in consulting or another client-facing environment, including leading workstreams, managing stakeholder relationships, mentoring junior professionals, and contributing to proposal development or business development.

Responsibilities

Analyze Medicaid claims, encounter, provider, member, eligibility, financial, and program data to identify trends, anomalies, risks, improper payment indicators, and opportunities for program improvement.
Support Medicaid program integrity, fraud, waste, and abuse, payment integrity, and third-party liability initiatives through policy and operational analysis, provider and member research, trend monitoring, and assessment of financial and program impacts.
Evaluate Medicaid policies, business rules, program operations, workflows, and controls to identify gaps, root causes, compliance concerns, and opportunities to strengthen program effectiveness and accountability.
Develop and interpret performance measures, reports, dashboards, analytical summaries, and other decision-support products for Medicaid leadership, program integrity teams, and project stakeholders.
Translate complex data, policy, compliance, and operational information into clear findings, risks, recommendations, and implementation considerations for technical and non-technical audiences.
Lead substantive analyses and workstreams; collaborate with program integrity, forensic, payment integrity, compliance, TPL, policy, data, and operational specialists; mentor junior staff; and contribute to proposals and the continued growth of BerryDunn’s Medicaid services.