Medicaid Compliance Subject Matter Expert (SME)

Overview

BerryDunn is seeking a Medicaid Compliance Subject Matter Expert (SME).

About the role

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.

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.

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.

Qualifications

• Minimum three (3) years of experience in a comparable Medicaid compliance, program integrity, audit, or consulting role preferred.

Skills

• Strong policy interpretation, documentation, and risk assessment skills.
• Experience working across operational, policy, analytical, and leadership stakeholders.

Benefits

The base salary range targeted for this role is $95,000-$130,000. This salary range represents BerryDunn’s good faith and reasonable estimate of the range of possible compensation at the time of posting. If an applicant possesses experience, education, or other qualifications more than the minimum requirements for this posting, that applicant is encouraged to apply, and a final salary range may then be based on those additional qualifications; compensation decisions are dependent on the facts and circumstances of each case.