Medicaid Program Integrity Consultant

Job Description: Client is seeking a Medicaid Program Integrity Senior Consultant to join our Medicaid consulting team in a subcontractor role. As part of our consulting team focused on state Medicaid agencies, you will leverage your Medicaid program integrity, auditing, and general Medicaid expertise to help Medicaid agencies implement programs to prevent and detect fraud, waste, and abuse. You’ll be a partner for Medicaid agencies in protecting local and federal resources, while facilitating trust in the programs individuals and families rely on. You will work remotely, with some trips to client sites, helping clients nationally. Successful candidates should be willing to support Guam, which will minimally require supporting the client from 8 am to 12 pm Tuesday through Friday Chamorro Standard Time (ChST). You will report to and partner with management team members supporting our Medicaid and Assurance team for client work. With a growth mindset, you will share your Medicaid expertise with those around you to help drive their development while also continuing to develop your own professional goals. Travel Expectations: Travel to client sites can range up to 30%. You Will: Help clients establish the procedures, tools, and knowledge required for the administration of Medicaid program integrity functions by analyzing federal and local requirements, assessing documents and data, and using your experience and judgment to make meaningful and actionable recommendations. Communicate directly with clients related to project activities, exercising sound judgment relying upon expertise and attention to detail to help project progress while providing excellent client service. Partner with the team to share your Medicaid program integrity expertise while supporting client needs and working collaboratively with the team to develop refined client service offerings. You Have: 10 + years working in a state Medicaid agency or the Centers for Medicare & Medicaid Services (CMS) with progressive responsibility related to Medicaid program integrity functions. Alternatively, 10+ years of experience with a state or public auditor’s office with a deep focus on Medicaid program integrity audits, or experience as a contractor with a vendor providing Medicaid program integrity services to federal or state agencies. Experience analyzing regulations and sub-regulatory guidance to inform program integrity activities, along with project management experience of program integrity initiatives. Experience performing audits of Medicaid program operations and of providers, including experience with audits focused on identifying fraud, waste, and abuse. Experience successfully navigating the dynamics of large government departments and agencies. Excellent written and verbal communication and team skills. Medical coding expertise is a plus. Apply To This Job