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Medicaid Program Integrity Jobs in Mississippi (NOW HIRING)

Parallon

Medicaid Eligibility Advocate

Jackson, MS · On-site

Participates in ongoing, comprehensive training programs as required. * Follows policies and ... integrity, collections, payment compliance, credentialing, health information management, customer ...

Noblesoft Technologies

SME Data Scientist

Jackson, MS · On-site

... Medicaid programs to develop organizational data strategy and improve data quality by reinforcing data integrity 3 years' experience with building and developing reports, including working with tools ...

Children's National

Nutrition Counselor

Shaw, MS · On-site

$20.83 - $34.71/hr

Connect families to external health and social services as appropriate (e.g., Medicaid, SNAP ... Program Integrity & Compliance * Uphold the highest standards of honesty and ethical conduct when ...

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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.

What job categories do people searching Medicaid Program Integrity jobs in Mississippi look for?

The top searched job categories for Medicaid Program Integrity jobs in Mississippi are:

What cities in Mississippi are hiring for Medicaid Program Integrity jobs?

Cities in Mississippi with the most Medicaid Program Integrity job openings:

Medicaid Program Integrity jobs near you
Infographic showing various Medicaid Program Integrity job openings in Mississippi as of August 2026, with employment types broken down into 100% Full Time. Highlights an 33% In-person, and 67% Remote job distribution.

Medicaid SME - MS - Medicaid

HCL Global Systems

Jackson, MS • On-site

Other

Re-posted 18 days ago

Job description

Description:
  • The Medicaid SME will provide subject matter expertise related to Medicaid program data, policies, and operational workflows to support the successful implementation and operationalization of the Program Integrity (PI) tool. The SME will collaborate with technical teams, program staff, vendors, and project leadership to ensure the PI solution effectively leverages Medicaid data to detect, prevent, and investigate fraud, waste, and abuse.

Key Responsibilities:
  • Data Domain Expertise - Provide expert guidance related to the structure, relationships, and usage of Medicaid data domains, including:

Member Data:
  • Eligibility and enrollment data
  • Demographic and coverage information
  • Managed care enrollment and attribution
  • Member identifiers and cross-system matching

Provider Data:
  • Provider enrollment and credentialing
  • Provider taxonomy and specialty classifications
  • Provider affiliations and group relationships
  • National Provider Identifier (NPI) and provider registry integration

Claims Data:
  • Professional, institutional, and pharmacy claims
  • Claim lifecycle and adjudication processes
  • Service codes (CPT, HCPCS, ICD, DRG)
  • Payment and encounter processing
  • Claims adjustments, voids, and resubmissions

Managed Care Data:
  • Managed Care Organization (MCO) encounter data
  • Capitation payments
  • Managed care reporting requirements
  • Encounter-to-claim mapping and validation

Program Integrity Support:
  • Advising on data requirements for fraud, waste, and abuse detection
  • Assisting with data mapping and data model validation for the PI tool
  • Supporting development of analytics, rules, and investigative workflows
  • Identifying data quality issues and remediation strategies
  • Helping define use cases and investigative scenarios
  • Ensuring accurate interpretation of Medicaid policy and program rules within the tool

Implementation Support:
  • Collaborating with system integrators and vendors on data ingestion and transformation
  • Supporting data validation, testing, and reconciliation
  • Participating in requirements gathering and design sessions
  • Providing business context for technical teams
  • Reviewing system outputs for accuracy and relevance
  • Supporting User Acceptance Testing (UAT)

Stakeholder Collaboration:
  • Program Integrity leadership
  • Data analytics teams
  • Medicaid program staff
  • IT and data architecture teams
  • System implementation vendors
  • Managed Care oversight teams

Work Products:
  • Medicaid data domain documentation validation
  • Data mapping and data dictionary validation
  • Program Integrity use cases and business rules validation
  • Data quality assessments and recommendations
  • Support documentation for system configuration validation
  • UAT participation and validation feedback
  • Implementation support reports and findings validation

Note:
  • Applicants who do not meet all of the required skills/experience minimums may not be considered further.
  • The awarded applicant will be required to execute a Business Associate Agreement (BAA) with DOM.
  • The period of performance will be for one-year intervals with the ability to renew for up to five (5) years based on mutual agreement of the parties.

Required Skills/Experience
Provide the minimum required skills and/or experience the contractor must possess to qualify for this position. These requirements will be transferred to the Score Sheet and candidates without these requirements reflected on their resume will NOT be presented to the manager for consideration.
The Medicaid SME must possess:
  • Minimum of 15 years of experience working with Medicaid program data and operations

Demonstrated expertise in the following Medicaid data domains:
  • Member/Eligibility data
  • Provider enrollment data
  • Claims and encounter data
  • Managed care program data
  • Experience working with Gainwell Medicaid Management Information Systems (MMIS) or successor platforms
  • Strong understanding of Medicaid program policies and regulatory requirements
  • Experience supporting large system implementations or modernization projects
  • Ability to communicate complex Medicaid data concepts to technical and non-technical stakeholders

Preferred / Not Required:
Provide any skills/experience that would be helpful for the candidate to possess but not required. Examples: Previous supervisory experience, WebLogic experience helpful, etc.
  • Experience implementing and managing Provider Enrollment systems
  • Experience implementing claims systems and managing claims data
  • Familiarity with CMS reporting and compliance requirements
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About HCL Global Systems

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HCL Global Systems is One of the Best IT Consulting Firm specialized in Application Development, Quality Testing, IT Courses Training, Staffing and Recruitment services. With wide range of experience, We are confident in our ability to help our Customers grow and improve their businesses. More than likely, regardless of the nature and scope of the problem, Our dedicated Team of Professionals can help you to achieve a cost effective business solution.

Industry

It services

Company size

1,001 - 5,000 Employees

Headquarters location

Farmington Hills, MI, US

Year founded

2005

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