You are expected to be a guardian of PwC's reputation, understanding that quality, integrity ... program design Travel Requirements Up to 80% Job Posting End Date The salary range for this ...
You are expected to be a guardian of PwC's reputation, understanding that quality, integrity ... program design Travel Requirements Up to 80% Job Posting End Date The salary range for this ...
Program Manager
Salt Lake City, UT · On-site
Our Company Is Looking for an ACT Team Manager who Oversees Daily Operations and Clinical Integrity ... Medicaid/Medicare and Accreditation Standards • Track Performance Metrics (Hospitalizations ...
Program Manager
Salt Lake City, UT · On-site
Our Company Is Looking for an ACT Team Manager who Oversees Daily Operations and Clinical Integrity ... Medicaid/Medicare and Accreditation Standards • Track Performance Metrics (Hospitalizations ...
Program Manager
Salt Lake City, UT · On-site
Our Company Is Looking for an ACT Team Manager who Oversees Daily Operations and Clinical Integrity ... Medicaid/Medicare and Accreditation Standards • Track Performance Metrics (Hospitalizations ...
Program Manager
Salt Lake City, UT · On-site
Our Company Is Looking for an ACT Team Manager who Oversees Daily Operations and Clinical Integrity ... Medicaid/Medicare and Accreditation Standards • Track Performance Metrics (Hospitalizations ...
Payment integrity (PI) programs Preferred Qualifications Experience with Medicare, Medicaid, and/or Marketplace lines of business. Certified Business Analysis Professional (CBAP) or Certified Coding ...
Payment integrity (PI) programs Preferred Qualifications Experience with Medicare, Medicaid, and/or Marketplace lines of business. Certified Business Analysis Professional (CBAP) or Certified Coding ...
Payment integrity (PI) programs Preferred Qualifications Experience with Medicare, Medicaid, and/or Marketplace lines of business. Certified Business Analysis Professional (CBAP) or Certified Coding ...
Payment integrity (PI) programs Preferred Qualifications Experience with Medicare, Medicaid, and/or Marketplace lines of business. Certified Business Analysis Professional (CBAP) or Certified Coding ...
Lead Overpayment Recovery Analyst, Payment Integrity - Health Plan (Remote)
West Valley City, UT · Remote
Payment integrity (PI) programs Preferred Qualifications Experience with Medicare, Medicaid, and/or Marketplace lines of business. Certified Business Analysis Professional (CBAP) or Certified Coding ...
Lead Overpayment Recovery Analyst, Payment Integrity - Health Plan (Remote)
West Valley City, UT · Remote
Payment integrity (PI) programs Preferred Qualifications Experience with Medicare, Medicaid, and/or Marketplace lines of business. Certified Business Analysis Professional (CBAP) or Certified Coding ...
Lead Overpayment Recovery Analyst, Payment Integrity - Health Plan (Remote)
Salt Lake City, UT · Remote
Payment integrity (PI) programs Preferred Qualifications Experience with Medicare, Medicaid, and/or Marketplace lines of business. Certified Business Analysis Professional (CBAP) or Certified Coding ...
Lead Overpayment Recovery Analyst, Payment Integrity - Health Plan (Remote)
Salt Lake City, UT · Remote
Payment integrity (PI) programs Preferred Qualifications Experience with Medicare, Medicaid, and/or Marketplace lines of business. Certified Business Analysis Professional (CBAP) or Certified Coding ...
Payment integrity (PI) programs Preferred Qualifications Experience with Medicare, Medicaid, and/or Marketplace lines of business. Certified Business Analysis Professional (CBAP) or Certified Coding ...
Payment integrity (PI) programs Preferred Qualifications Experience with Medicare, Medicaid, and/or Marketplace lines of business. Certified Business Analysis Professional (CBAP) or Certified Coding ...
... Integrity, and other Client Success staff to execute contractual obligations. The CSP will also ... Understand and continually monitor Federal, state, and local Medicaid School-Based program policies
... Integrity, and other Client Success staff to execute contractual obligations. The CSP will also ... Understand and continually monitor Federal, state, and local Medicaid School-Based program policies
Payer Quality Consultant, Director
$155K - $410K/yr
You are expected to be a guardian of PwC's reputation, understanding that quality, integrity ... Medicaid program requirements - Leading teams to generate a vision and trust - Building ...
Payer Quality Consultant, Director
$155K - $410K/yr
You are expected to be a guardian of PwC's reputation, understanding that quality, integrity ... Medicaid program requirements - Leading teams to generate a vision and trust - Building ...
MDS Coordinator Full Time
Orem, UT · On-site
$29.75 - $38/hr
Really! Our guiding motto is leading with integrity, empowering people, delivering outcomes ... Create the schedule for all Medicare and Medicaid including: * Start Medicare coverage for newly ...
MDS Coordinator Full Time
Orem, UT · On-site
$29.75 - $38/hr
Really! Our guiding motto is leading with integrity, empowering people, delivering outcomes ... Create the schedule for all Medicare and Medicaid including: * Start Medicare coverage for newly ...
Reimbursement Specialist II
Salt Lake City, UT · On-site +1
$23 - $27/hr
... Medicaid, private payer and patient billing, and accounts receivable tracking and follow-up. ... Integrity: We are honest and professional. * Trust: We count on each other. * Excellence: We strive ...
Reimbursement Specialist II
Salt Lake City, UT · On-site +1
$23 - $27/hr
... Medicaid, private payer and patient billing, and accounts receivable tracking and follow-up. ... Integrity: We are honest and professional. * Trust: We count on each other. * Excellence: We strive ...
Reimbursement Specialist II
Salt Lake City, UT · On-site
$23 - $27/hr
... Medicaid, private payer and patient billing, and accounts receivable tracking and follow-up. ... Integrity: We are honest and professional. * Trust: We count on each other. * Excellence: We strive ...
Reimbursement Specialist II
Salt Lake City, UT · On-site
$23 - $27/hr
... Medicaid, private payer and patient billing, and accounts receivable tracking and follow-up. ... Integrity: We are honest and professional. * Trust: We count on each other. * Excellence: We strive ...
Board Certified Behavior Analyst
Layton, UT · On-site
$67K - $82K/yr
... integrity. * Maintain strong and collaborative communication with families, caregivers, clinical ... Familiarity with Medicaid / payer documentation requirements and utilization expectations.
Quick apply
Board Certified Behavior Analyst
Layton, UT · On-site
$67K - $82K/yr
... integrity. * Maintain strong and collaborative communication with families, caregivers, clinical ... Familiarity with Medicaid / payer documentation requirements and utilization expectations.
Board Certified Behavior Analyst
Layton, UT · On-site
$67K - $82K/yr
... integrity. * Maintain strong and collaborative communication with families, caregivers, clinical ... Familiarity with Medicaid / payer documentation requirements and utilization expectations.
Board Certified Behavior Analyst
Layton, UT · On-site
$67K - $82K/yr
... integrity. * Maintain strong and collaborative communication with families, caregivers, clinical ... Familiarity with Medicaid / payer documentation requirements and utilization expectations.
... Cannabis, Medicaid, and the Children's Health Insurance Program (CHIP). Hearing Management ... Administrative Integrity * Maintain accurate case files, records, and exhibits. * Assist with ...
... Cannabis, Medicaid, and the Children's Health Insurance Program (CHIP). Hearing Management ... Administrative Integrity * Maintain accurate case files, records, and exhibits. * Assist with ...
Reimbursement Supervisor
Salt Lake City, UT · On-site +1
$60K - $70K/yr
Integrity: We are honest and professional. * Trust: We count on each other. * Excellence: We strive ... Generate weekly list of all Medicare/Medicaid, Private Insurance and Self Pay revenue and ...
Reimbursement Supervisor
Salt Lake City, UT · On-site +1
$60K - $70K/yr
Integrity: We are honest and professional. * Trust: We count on each other. * Excellence: We strive ... Generate weekly list of all Medicare/Medicaid, Private Insurance and Self Pay revenue and ...
Integrity: We are honest and professional. * Trust: We count on each other. * Excellence: We strive ... Generate weekly list of all Medicare/Medicaid, Private Insurance and Self Pay revenue and ...
Integrity: We are honest and professional. * Trust: We count on each other. * Excellence: We strive ... Generate weekly list of all Medicare/Medicaid, Private Insurance and Self Pay revenue and ...
... programs. * Own ASC 606 technical positions, policies, and revenue models. * Approve monthly ... Ensure accurate Medicare/Medicaid reporting, including allowances, LUPA/RAP impacts, hospice cap ...
... programs. * Own ASC 606 technical positions, policies, and revenue models. * Approve monthly ... Ensure accurate Medicare/Medicaid reporting, including allowances, LUPA/RAP impacts, hospice cap ...
... programs. * Own ASC 606 technical positions, policies, and revenue models. * Approve monthly ... Ensure accurate Medicare/Medicaid reporting, including allowances, LUPA/RAP impacts, hospice cap ...
Quick apply
... programs. * Own ASC 606 technical positions, policies, and revenue models. * Approve monthly ... Ensure accurate Medicare/Medicaid reporting, including allowances, LUPA/RAP impacts, hospice cap ...
Medicaid Program Integrity information
What is the difference between Medicaid Program Integrity vs Medicaid Claims Examiner?
| Aspect | Medicaid Program Integrity | Medicaid Claims Examiner |
|---|---|---|
| Primary Focus | Detecting and preventing fraud, waste, and abuse in Medicaid programs | Reviewing and processing Medicaid claims for accuracy and compliance |
| Required Credentials | Typically healthcare or compliance certifications, knowledge of Medicaid policies | Healthcare or claims processing certifications, attention to detail |
| Work Environment | Regulatory agencies, government offices, compliance departments | Insurance companies, healthcare providers, government Medicaid offices |
Medicaid Program Integrity professionals focus on safeguarding Medicaid funds by identifying fraudulent activities, while Medicaid Claims Examiners primarily verify claims for accuracy and proper coding. Both roles require healthcare knowledge and certifications but differ in their core responsibilities and work settings.

$155K - $410K/yr
Full-time
Medical, Dental, Vision, Retirement, PTO
Posted 29 days ago
PwC rating
8.3
Based on 73 frontline employees who took The Breakroom Quiz
20th of 57 rated business consultants
Job description
Industry/Sector
Health ServicesSpecialism
OperationsManagement Level
DirectorJob Description & Summary
At PwC, our people in operations consulting specialise in providing consulting services on optimising operational efficiency and effectiveness. These individuals analyse client needs, develop operational strategies, and offer guidance and support to help clients streamline processes, improve productivity, and drive business performance.As an operations consulting generalist at PwC, you will possess a broad understanding of various aspects of operations consulting. You will provide comprehensive guidance and support to clients in optimising operational efficiency and effectiveness. Working in this area, you will analyse client needs, develop operational solutions, and offer recommendations tailored to specific business requirements.
Translating the vision, you set the tone, and inspire others to follow. Your role is crucial in driving business growth, shaping the direction of client engagements, and mentoring the next generation of leaders. You are expected to be a guardian of PwC's reputation, understanding that quality, integrity, inclusion and a commercial mindset are all foundational to our success. You create a healthy working environment while maximising client satisfaction. You cultivate the potential in others and actively team across the PwC Network, understanding tradeoffs, and leveraging our collective strength.
Examples of the skills, knowledge, and experiences you need to lead and deliver value at this level include but are not limited to:
Lead in line with our values and brand.
Develop new ideas, solutions, and structures; drive thought leadership.
Solve problems by exploring multiple angles and using creativity, encouraging others to do the same.
Balance long-term, short-term, detail-oriented, and big picture thinking.
Make strategic choices and drive change by addressing system-level enablers.
Promote technological advances, creating an environment where people and technology thrive together.
Identify gaps in the market and convert opportunities to success for the Firm.
Adhere to and enforce professional and technical standards (e.g. refer to specific PwC tax and audit guidance) the Firm's code of conduct, and independence requirements.
The Opportunity
As part of the Operations Consulting team you will drive the strategic direction and execution of innovative Medicaid programs. As a Director you will set the vision for business growth, mentor future leaders, and maintain impactful executive-level client relations, making sure that our initiatives align with the utmost standards of quality and integrity.
Responsibilities
- Establish a vision for business expansion and sustainability
- Mentor and develop emerging leaders within the team
- Identify and leverage market opportunities for growth
- Foster collaboration across teams to enhance service delivery
- Promote a culture of innovation and continuous improvement
What You Must Have
- Bachelor's Degree
- At least 10 years of experience
What Sets You Apart
- Master's Degree in Health Administration, Business Administration/Management, Public Policy Analysis, Public Health, Economics, Government preferred
- Demonstrating thought-leader level abilities in Medicaid programs
- Designing and launching Medicaid programs for growth
- Enhancing existing Medicaid programs within regulatory environments
- Utilizing Medicaid data for financial modeling and insights
- Leading teams to generate vision and trust
- Building collaborative relationships and providing guidance
- Managing complex operations tasks and projects
- Communicating effectively in written and verbal formats
- Leveraging quantitative analyses to construct analytical frameworks and synthesize complex data into meaningful insights
- Possessing experience with Health Plan Medicaid operations, finances, business processes, and program design
Travel Requirements
Up to 80%Job Posting End Date
The salary range for this position is: $155,000 - $410,000. Actual compensation within the range will be dependent upon the individual's skills, experience, qualifications and location, and applicable employment laws. All hired individuals are eligible for an annual discretionary bonus. PwC offers a wide range of benefits, including medical, dental, vision, 401k, holiday pay, vacation, personal and family sick leave, and more. To view our benefits at a glance, please visit the following link: https://pwc.to/benefits-at-a-glanceAs PwC is anequal opportunity employer, all qualified applicants will receive consideration for employment at PwC without regard to race; color; religion; national origin; sex (including pregnancy, sexual orientation, and gender identity); age; disability; genetic information (including family medical history); veteran, marital, or citizenship status; or, any other status protected by law.PwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: https://pwc.to/H-1B-Lottery-Policy.Learn more about how we work: https://pwc.to/how-we-workFor only those qualified applicants that are impacted by the Los Angeles County Fair Chance Ordinance for Employers, the Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Francisco Fair Chance Ordinance, San Diego County Fair Chance Ordinance, and the California Fair Chance Act, where applicable, arrest or conviction records will be considered for Employment in accordance with these laws. At PwC, we recognize that conviction records may have a direct, adverse, and negative relationship to responsibilities such as accessing sensitive company or customer information, handling proprietary assets, or collaborating closely with team members. We evaluate these factors thoughtfully to establish a secure and trusted workplace for all.Applications will be accepted until the position is filled or the posting is removed, unless otherwise set forth on the following webpage. Please visit this link for information about anticipated application deadlines: https://pwc.to/us-application-deadlines