Program Integrity Lead

About the role

BerryDunn is seeking a Program Integrity Lead to support Hawaiʻi Med-QUEST (MDQ).

Responsibilities

• Lead Medicaid program integrity activities, including fraud, waste, and abuse prevention; provider oversight; compliance monitoring; risk assessment; external audit coordination; recovery efforts; and Medicaid medical, dental, behavioral health, and pharmacy claims audits.
• Coordinate project priorities, client needs, vendor collaboration, Jira tracking, deliverable development, workgroup activity, and leadership reporting to support clear accountability, timely escalation, and consistent execution.
• Stand up and stabilize Program Integrity unit functions, including foundational processes, operating rhythms, documentation, roles, decision points, and quality controls.
• Build practical structure and rigor for Program Integrity operations, including repeatable workflows, reporting routines, escalation pathways, audit processes, corrective action tracking, and performance monitoring.
• Review and audit Medicaid medical, dental, behavioral health, and pharmacy claims for accuracy, legality, reasonableness, and alignment with Medicaid policies, regulations, billing requirements, and claims data.
• Interpret and apply Medicaid policy, federal and state requirements, and applicable code of federal regulations to support compliant program operations.
• Establish and monitor program integrity objectives, key performance indicators (KPIs), corrective action plans, and reporting processes.
• Analyze claims data, audit results, program integrity reports, recovery information, and related documentation to identify risks, trends, findings, and improvement opportunities.
• Develop or update policies, procedures, requirements, guidance, recommendations, training materials, and related program integrity documentation.
• Partner with MQD leadership and staff to support adoption of new Program Integrity processes, tools, expectations, and ways of working.
• Develop training, guidance, job aids, and transition materials to help MQD staff operate and sustain Program Integrity processes over time.
• Support knowledge transfer and handoff planning so Program Integrity responsibilities, documentation, tools, and operating practices can transition to MQD ownership at the appropriate time.
• Carefully coordinate priorities, assignments, action items, risks, blockers, dependencies, and follow-up activities across stakeholders, BerryDunn team members, vendor partners, and project leadership.
• Lead or co-lead workstream meetings, workgroups, planning sessions, and internal alignment discussions to support timely decisions, clear communication, and consistent follow-through.
• Maintain accurate workstream information in Jira, including tasks, action items, blockers, milestones, status notes, due dates, dependencies, priorities, and reporting updates.
• Support weekly and monthly project reporting, closeout materials, leadership updates, and client-facing status information.
• Review workstream documents, meeting notes, deliverables, recommendations, and client-facing materials for accuracy, consistency, quality, and alignment with project standards.
• Use SharePoint/KnowledgeLink to organize, maintain, and version project documentation consistent with document management expectations.
• Escalate risks, blockers, decisions, and support needs early through the appropriate workstream and project management pathways.

Qualifications

• Strong leadership, communication, facilitation, organization, and attention to detail.
• Knowledge of Medicaid program integrity, fraud, waste, and abuse prevention, provider oversight, claims review, audit support, compliance monitoring, or related public sector healthcare operations.
• Knowledge of quality assurance/control procedures, corrective action tracking, and proactive problem management.
• Demonstrated ability to work effectively in a team setting and coordinate across multiple stakeholders, including clients, vendors, project leadership, and internal teams.
• Experience using Jira or similar project management tools to track action items, status, ownership, deadlines, risks, blockers, dependencies, and deliverables.
• Experience coordinating recurring meetings, documenting follow-up items, maintaining workstream alignment, and supporting escalation pathways.
• Strong experience with Microsoft applications and artificial intelligence tools.

Preferred Qualifications/Experience

• Prior consulting experience in a national or regional consulting firm, experience working in or with a state Medicaid agency, and/or experience supporting Medicaid program integrity, audit, compliance, or claims operations.
• Three (3) years of experience within the last five (5) years in a comparable Medicaid program integrity, compliance, audit, policy, operations, project management, program management, or consulting role.
• Bachelor's Degree (BA/BS)—may substitute four years of applicable experience for the degree.
• Experience supporting healthcare, government, public sector, or Medicaid initiatives preferred.
• Experience managing complex projects involving multiple stakeholders, vendors, workstreams, risks, issues, and deliverables.
• Experience standing up, stabilizing, training on, or transitioning new operational units, programs, processes, or business functions.
• Preference will be given to candidates with certifications such as Certified Professional Coder (CPC), Certified Fraud Examiner (CFE), Certified Professional Medical Auditor (CPMA), Certified Internal Auditor (CIA), or equivalent credentials.

Benefits & Culture

We will ensure that individuals are provided reasonable accommodation to participate in the job application or interview process or perform essential job functions. Please contact careers@berrydunn.com to request an accommodation.

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace.

About BerryDunn

BerryDunn is the brand name under which Berry, Dunn, McNeil & Parker, LLC and BDMP Assurance, LLP, independently owned entities, provide services. Since 1974, BerryDunn has helped businesses, nonprofits, and government agencies throughout the US and its territories solve their greatest challenges. The firm’s tax, advisory, and consulting services are provided by Berry, Dunn, McNeil & Parker, LLC, and its attest services are provided by BDMP Assurance, LLP, a licensed CPA firm. BerryDunn is a client-centered, people-first professional services firm with a mission to empower the meaningful growth of our people, clients, and communities. Led by CEO Sarah Belliveau, the firm has been recognized for its efforts in creating a diverse and inclusive workplace culture, and for its focus on learning, development, and well-being.

Learn more at berrydunn.com.