第三方责任（TPL）负责人
Third Party Liability (TPL) Lead
BerryDunn正在寻找一位第三方责任（TPL）负责人，以支持夏威夷Med-QUEST的第三方责任、欺诈、浪费和滥用（FWA）、项目完整性及医疗补助TPL计划。该职位将负责TPL运营，包括成本避免、追偿、索赔相关流程、供应商协调、报告、质量保证和运营改进。
TPL负责人将监督TPL主题专家（SME）的工作，并与项目完整性负责人和政策负责人密切协作，确保TPL工作与项目完整性、审计、政策、流程和系统优先事项保持一致。该职位将帮助确保医疗补助作为最后支付者，通过与责任第三方（包括商业保险公司、医疗保险和责任保险公司）的协调和追偿来实现。
TPL负责人将在我们的项目结构内工作，并与集成IT、流程与政策、战略项目管理以及学习、发展与变革管理工作组紧密协作。
出差要求：该职位可能需要每年出差最多25%的时间。
你将
- 领导TPL运营和改进，包括成本避免、追偿、索赔相关流程、供应商协调、报告和质量保证。
- 监督TPL SME的工作，包括分析、建议、文档、运营支持和质量审查。
- 与项目完整性负责人和政策负责人协调，确保TPL活动与更广泛的合规、审计、政策、流程和系统优先事项保持一致。
- 为项目团队和利益相关者提供关于医疗补助TPL要求、最佳实践、运营考虑和合规期望的指导。
- 支持日常TPL单元运营，包括与MQD单元、供应商、健康计划、民事追偿部门和其他合作伙伴的协调。
- 领导或支持开发、跟踪和优化TPL索赔相关流程和文档。
- 主持会议，管理后续行动，跟踪决策，上报风险和障碍，并支持及时解决问题。
- 审查现有TPL流程，领导业务流程重新设计以提高效率、合规性、问责制和追偿结果。
- 审查TPL供应商负责人文件、已验证的政策更新、成本避免报告、追偿报告和相关运营数据。
- 遵循项目工作方式标准，包括文档管理、客户沟通、时间记录、内部审核周期
查看英文原文
Overview
BerryDunn is seeking a Third Party Liability (TPL) Lead to support Hawaiʻi Med-QUEST’s Third Party Liability, Fraud, Waste, and Abuse (FWA), program integrity, and Medicaid TPL initiatives. This role will lead TPL operations, including cost avoidance, recovery, lien-related processes, vendor coordination, reporting, quality assurance, and operational improvements.
The TPL Lead will oversee the TPL Subject Matter Expert (SME) and coordinate closely with the Program Integrity Lead and Policy Lead to align TPL work with program integrity, audit, policy, process, and systems priorities. This role will help ensure Medicaid acts as the payer of last resort by supporting coordination and recovery from liable third parties, including commercial insurers, Medicare, and casualty or liability carriers.
The TPL Lead will work within our project structure, with close coordination across Integrated IT, Process & Policy, Strategic Project Management, and Learning, Development & Change Management workstreams.
Travel expectations: This role may require travel up to 25% of the year.
You Will
- Lead TPL operations and improvements, including cost avoidance, recovery, lien-related processes, vendor coordination, reporting, and quality assurance.
- Oversee the TPL SME’s work, including analysis, recommendations, documentation, operational support, and quality review.
- Coordinate with the Program Integrity Lead and Policy Lead to align TPL activities with broader compliance, audit, policy, process, and systems priorities.
- Provide guidance to project teams and stakeholders on Medicaid TPL requirements, best practices, operational considerations, and compliance expectations.
- Support daily TPL Unit operations, including coordination with MQD units, vendors, health plans, the Civil Recoveries Division, and other partners.
- Lead or support development, tracking, and refinement of TPL lien-related processes and documentation.
- Facilitate meetings, manage follow-up actions, track decisions, escalate risks and blockers, and support timely issue resolution.
- Review existing TPL processes and lead business process redesign to improve efficiency, compliance, accountability, and recovery outcomes.
- Review TPL vendor lead files, verified policy updates, cost avoidance reports, recovery reports, and related operational data.
- Follow project ways-of-working standards, including document management, client communication, time entry, internal review cycles, and protection of sensitive information.
You Have
Experience leading or supporting Medicaid Third Party Liability (TPL), program integrity, recovery, cost avoidance, audit, compliance, policy, or related operations.
Strong knowledge of Medicaid coordination of benefits, third-party payer data, recovery processes, lien-related processes, federal and state TPL requirements, and payer-of-last-resort principles.
- Experience coordinating TPL-related work across program, vendor, legal, finance, policy, analytics, claims, eligibility, audit, and project management stakeholders.
- Experience interpreting and applying federal and state Medicaid requirements.
- Strong project leadership, facilitation, communication, analytical, and stakeholder engagement skills.
- Ability to analyze Medicaid claims, eligibility systems, third-party payer data, recovery opportunities, and operational improvements.
- Experience leading or supporting business process redesign in a Medicaid, healthcare, claims, eligibility, program integrity, or TPL environment.
- Experience overseeing or coordinating the work of subject matter experts, analysts, or project team members.
- Ability to collaborate across multidisciplinary workstreams, including strategic project management, integrated IT/process/policy, audit, operations, training, communications, and change management teams.
- Minimum three (3) years of experience within the last five (5) years in a comparable Medicaid, healthcare, TPL, program integrity, operations, leadership, or consulting role.
Preferred Qualifications/Experience:
- Experience supporting or leading a state Medicaid agency TPL program, including cost avoidance, recovery, casualty/liability, lien-related processes, audit, compliance, coordination of benefits, or vendor coordination.
- Experience supporting implementation activities such as process redesign, reporting, testing, training readiness, release coordination, performance monitoring, or stabilization.
- Familiarity with Medicaid eligibility systems, claims systems, integrated eligibility systems, or vendor-managed Medicaid data environments is a plus.
Compensation Details
The base salary range targeted for this role is $90,000-$120,000. 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. The salary of the finalist selected for this role will be based on a variety of factors, including but not limited to, years of experience, depth of experience, seniority, merit, education, training, amount of travel, and other relevant business considerations.
BerryDunn Benefits & Culture
Our people are what make BerryDunn special, and in return we strive to support our employees and help them thrive. Eligible employees have access to benefits that go beyond what’s expected to support their physical, mental, career, social, and financial well-being. Visit our website for a complete list of benefits and a look into our culture: Experience BerryDunn.
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 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.
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Originally posted on Himalayas