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Medicaid Program Integrity Jobs in Arizona (NOW HIRING)

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Phoenix, AZ ยท On-site

$50K - $60K/yr

AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards ... and integrity (analyze claims, encounter data, review medical records, conduct on-site visits ...

Auditor 3

Phoenix, AZ ยท On-site +1

$50K - $60K/yr

AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards ... and integrity (analyze claims, encounter data, review medical records, conduct on-site visits ...

Auditor 3

Phoenix, AZ ยท On-site

$50K - $60K/yr

AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards ... and integrity (analyze claims, encounter data, review medical records, conduct on-site visits ...

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Phoenix, AZ ยท On-site

$70K - $75K/yr

AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards ... Promote data integrity, consistency, and appropriate use of healthcare data by supporting data ...

GRANTS MANAGER

Phoenix, AZ ยท On-site +1

$75K - $90K/yr

Arizona's Rural Health Transformation Program is supported by the Centers for Medicare & Medicaid ... integrity. Ensure timely resolution of compliance issues, audit findings, and questioned costs.

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Phoenix, AZ ยท On-site

$75K - $90K/yr

Arizona's Rural Health Transformation Program is supported by the Centers for Medicare & Medicaid ... integrity. Ensure timely resolution of compliance issues, audit findings, and questioned costs.

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Phoenix, AZ ยท On-site

$102K/yr

AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards ... integrity, accuracy, and audit-ready documentation across systems and partners. โ€ข Reporting ...

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Phoenix, AZ ยท On-site

$75K/yr

AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards ... Collaborate with the Evaluation & Data Manager to ensure data integrity, validation, and ...

Accounting Supervisor 1

Phoenix, AZ ยท On-site

$70K - $80K/yr

AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards ... ensure system integrity and timely disbursement of payments and recording of expenditures.

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Medicaid Program Integrity information

What is the difference between Medicaid Program Integrity vs Medicaid Claims Examiner?

AspectMedicaid Program IntegrityMedicaid Claims Examiner
Primary FocusDetecting and preventing fraud, waste, and abuse in Medicaid programsReviewing and processing Medicaid claims for accuracy and compliance
Required CredentialsTypically healthcare or compliance certifications, knowledge of Medicaid policiesHealthcare or claims processing certifications, attention to detail
Work EnvironmentRegulatory agencies, government offices, compliance departmentsInsurance 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.

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Deputy Center Director (Medicaid Program Integrity)

Phoenix, AZ โ€ข On-site

$115K/yr

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Job description

This position is located in the Center for Program Integrity (CPI) at the Centers for Medicare and Medicaid Services (CMS).

As the Deputy Center Director (Medicaid Program Integrity), you will provide executive leadership, direction and coordination for the management of a cohesive, agency-wide approach to ensuring program integrity across the Medicaid and Children's Health Insurance Program (CHIP). Candidates should be committed to improving the efficiency of the Federal government, passionate about the ideals of our American republic, and committed to upholding the rule of law and the United States Constitution. Candidates will not be hired based on their race, sex, color, religion, or national origin.

To meet the minimum qualification requirements for this position, you must show that you possess the Executive Core Qualifications (ECQ) and Technical Qualifications (TQ) related to this position within your resume - NOT TO EXCEED 2 PAGES. Resumes over the 2-page limit, will not be reviewed beyond page 2 or may be disqualified. Your resume should include examples of experience, education, and accomplishments applicable to the qualification(s). If your resume does not reflect demonstrated evidence of these qualifications, you may not receive consideration for the position.

There is NO requirement to prepare a narrative statement specifically addressing the Executive Core Qualifications (ECQs) or the Technical Qualifications (TQs).

TECHNICAL QUALIFICATIONS (TQs): Your resume should demonstrate accomplishments that would satisfy the technical qualifications.

TQ 1: Demonstrated executive-level experience leading national program integrity efforts for Medicaid, the Children's Health Insurance Program (CHIP), or similar Federal health care programs. This includes developing and leading strategies to prevent, detect, and address fraud, waste, abuse, and improper payments; overseeing nationwide provider oversight and enforcement activities; coordinating audits, investigations, and corrective actions with Federal and State agencies, State Medicaid Fraud Control Units (MFCUs), and law enforcement partners; and achieving measurable results that improved program integrity, strengthened accountability, or reduced improper payments across the country.

TQ 2: Demonstrated executive-level experience integrating program integrity into enterprise strategy, policy development, and national operational frameworks for Medicaid, the Children's Health Insurance Program (CHIP), or comparable Federal health care programs. This includes identifying gaps in statutory, regulatory, or policy frameworks; developing and implementing policy, regulatory, or operational solutions to address emerging risks and program vulnerabilities; aligning program integrity initiatives with agency-wide strategic planning, budget priorities, and legislative proposals; and advising senior leadership on program integrity strategy, risk management, and national policy direction.

EXECUTIVE CORE QUALIFICATIONS (ECQs): In addition to the Technical Qualification Requirements listed above, all new entrants into the Senior Executive Service (SES) under a career appointment will be assessed for executive competency against the following five mandatory ECQs. If your 2-page resume does not reflect demonstrated evidence of the ECQs and TQs, you may not receive further consideration for the position.

There are five ECQs:

  • ECQ 1: Commitment to the Rule of Law and the Principles of the American Founding - This core qualification requires a demonstrated knowledge of the American system of government, commitment to uphold the Constitution and the rule of law, and commitment to serve the American people.
  • ECQ 2: Driving Efficiency - This core qualification involves the demonstrated ability to strategically and efficiently manage resources, budget effectively, cut wasteful spending, and pursue efficiency through process and technological upgrades.
  • ECQ 3: Merit and Competence - This core qualification involves the demonstrated knowledge, ability and technical competence to effectively and reliably produce work that is of exceptional quality.
  • ECQ 4: Leading People - This core qualification involves the demonstrated ability to lead and inspire a group toward meeting the organization's vision, mission, and goals, and to drive a high-performance, high-accountability culture. This includes, when necessary, the ability to lead people through change and to hold individuals accountable.
  • ECQ 5: Achieving Results - This core qualification involves the demonstrated ability to achieve both individual and organizational results, and to align results to stated goals from superiors.

Note: If you are a member of the SES or have been certified through successful participation in an OPM approved SES Candidate Development Program (SESCDP), or have SES reinstatement eligibility, you do not need to respond to the ECQs. Instead, you should attach proof (e.g., SF-50, Certification by OPM's SES Qualifications Review Board (QRB)) of your eligibility for noncompetitive appointment to the SES.

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