Third-Party Liability (TPL) Medicaid Subject Matter Expert (SME)

BerryDunn

92d • $85,000 - $115,000

About The Position

BerryDunn is seeking a Third-Party Liability (TPL) Subject Matter Expert (SME) to join our Medicaid Practice Group. This position will support client work for a State Health and Human Services (HHS) agency that has requested subject matter expertise and technical support services to strengthen and enhance its TPL program. The TPL SME will focus on ensuring Medicaid operates as the payer of last resort by supporting identification, coordination, and recovery of payments from liable third parties such as commercial insurers, Medicare, and casualty/liability carriers. In this role, the TPL SME will review existing TPL processes, support business process redesign (BPR) efforts, and provide guidance to agency staff on compliance with federal and state requirements. The position will also provide support for audits, federal reporting, and quality assurance activities related to TPL recovery. In addition, the TPL SME will be responsible for assisting the agency in policy interpretation, training development, and data analysis to maximize recoveries and strengthen operational efficiency. Your initial focus will be on supporting our Hawai'i client. You will report to and partner with senior management in our Medicaid team, both for client work and career development. With a growth mindset, you will drive your development with the support of a learning and development culture. This position offers flexibility in work location, with the option to work fully onsite or in a hybrid capacity. Given that you may be collaborating with teams across multiple time zones, you will need to manage your schedule effectively to ensure availability for meetings and meet deadlines, while having the freedom to work independently when necessary. Travel Expectations: Travel to client sites can range up to 50%.

Requirements

• Ability to conduct research and analysis related to Medicaid claims, eligibility systems, and third-party payer data to identify recovery opportunities.
• Strong knowledge of federal and state TPL requirements and coordination of benefits processes.
• Prior experience supporting a state Medicaid agency TPL program (preferred experience in cost avoidance, recovery, or related audit/compliance activities).
• Experience reviewing processes and supporting business process redesign (BPR) efforts.
• Strong experience with Microsoft Excel, Word, and PowerPoint, and ability to work with Medicaid eligibility and claims processing systems.
• Demonstrated ability to interpret and apply complex regulations, policies, and contracts related to Medicaid and TPL.
• Excellent written and verbal communication skills, with the ability to convey technical TPL concepts clearly to staff, leadership, and external partners.

Responsibilities

• Provide frequent, clear, and consistent communication to the client, team members, vendors, and stakeholders regarding TPL activities and outcomes.
• Participate in TPL unit and/or cross-functional Medicaid team meetings to provide SME input and updates.
• Perform quality reviews of claims, eligibility records, and third-party data to ensure Medicaid is acting as the payer of last resort.
• Review existing TPL processes and support business process redesign (BPR) efforts to increase efficiency, compliance, and recovery outcomes.
• Serve as an SME on TPL policies, regulations, and recovery processes, guiding staff and State leadership.
• Aid in the development of policies, procedures, and training materials to strengthen TPL operations.
• Support audits, federal reporting, and compliance reviews related to TPL performance and recovery.
• Perform assigned administrative and technical tasks efficiently and effectively, asking questions when instructions are unclear.

Benefits

• Access to benefits that support physical, mental, career, social, and financial well-being.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 501-1,000 employees