Medicaid Program Integrity Senior Consultant

Overview:

We are seeking a Medicaid Program Integrity Senior Consultant who will support our client. This position offers the opportunity to partner with state Medicaid agencies and the Centers for Medicare & Medicaid Services (CMS) to implement effective program integrity initiatives that prevent and detect fraud, waste, and abuse. You will help Medicaid agencies safeguard federal and state resources while supporting access to vital healthcare services.

Duties:

• Establish and improve Medicaid program integrity procedures, tools, and knowledge through regulatory analysis, documentation review, and data assessment.

• Provide actionable recommendations to clients to strengthen program integrity functions.

• Conduct audits of Medicaid program operations and providers, with a focus on identifying fraud, waste, and abuse.

• Analyze federal and state regulations and sub-regulatory guidance to inform Medicaid program integrity activities.

• Manage and support program integrity initiatives, ensuring timely and accurate project delivery.

• Communicate effectively with clients, exercising sound judgment, expertise, and attention to detail to support project progress and client satisfaction.

• Collaborate with team members to enhance client service offerings and share program integrity knowledge.

• Support professional development of peers while pursuing continuous growth in your own expertise.

Mandatory Qualifications:

• 10+ years of experience working in a state Medicaid agency, CMS, or public auditor's office with progressive responsibility in Medicaid program integrity functions.

• Demonstrated expertise in Medicaid program integrity audits or in providing program integrity services as a contractor/vendor.

• Strong experience analyzing regulations and sub-regulatory guidance to inform program integrity work.

• Proven project management experience related to program integrity initiatives.

• Extensive experience conducting audits of Medicaid program operations and providers, including investigations into fraud, waste, and abuse.

• Demonstrated success in navigating large government departments and agency structures.

• Excellent written, verbal, and interpersonal communication skills.

• Strong team collaboration skills with the ability to lead, mentor, and partner effectively.

Desirable Qualifications:

• Medical coding expertise.

• Previous consulting experience supporting state Medicaid agencies.

• Familiarity with Guam Medicaid programs or working across diverse geographic regions.