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Medicaid Program Integrity Jobs (NOW HIRING)

BOTG LLC

Medical Coder Reviewer

Columbia, SC · Remote

$15.25 - $20.50/hr

Prepares listings of codes changes to Reference Administration staff and Medicaid Program staff for ... program integrity, or appeals. 5+ years working with IT developers/programmers in a payor ...

Arizona State Hospital

Job Page

Phoenix, AZ · On-site

$77K - $82K/yr

AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards ... integrity, and data-driven decision making throughout the data lifecycle. Major duties and ...

Commence

Medicaid Client Executive

Annapolis Junction, MD · On-site

$78K - $106K/yr

Build, establish, and mature trusted partnerships with state health officials, policy leaders, Medicaid directors, clinical integrity leaders, public health executives, and state payer program ...

Barrow Wise Consulting

Medicaid/Medicare Consultant

MD · On-site

$90K - $150K/yr

... and Medicaid programs; provide IDHS with detailed information identifying those claims that the ... Our employees stand behind Barrow Wise's core values of integrity, quality, innovation, and ...

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All JobsMedicaid Program Integrity Jobs

Medicaid Program Integrity information

See salary details

$21.5K

$45.7K

$63K

How much do medicaid program integrity jobs pay per year?

As of Jun 8, 2026, the average yearly pay for medicaid program integrity in the United States is $45,721.00, according to ZipRecruiter salary data. Most workers in this role earn between $37,500.00 and $47,500.00 per year, depending on experience, location, and employer.

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.

More about Medicaid Program Integrity jobs
What cities are hiring for Medicaid Program Integrity jobs? Cities with the most Medicaid Program Integrity job openings:
What states have the most Medicaid Program Integrity jobs? States with the most job openings for Medicaid Program Integrity jobs include:
What job categories do people searching Medicaid Program Integrity jobs look for? The top searched job categories for Medicaid Program Integrity jobs are:
Medicaid Program Integrity jobs near you
Infographic showing various Medicaid Program Integrity job openings in the United States as of May 2026, with employment types broken down into 60% Full Time, 20% Temporary, and 20% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $45,721 per year, or $22 per hour.

Medicaid Business/QA Analyst

MSR Technology Group

Springfield, IL • Remote

Contractor

Posted 27 days ago

Job description

Medicaid Business / QA Analyst
  • 7–12+ Month Contract | Remote | No ThirdParty Firms | Medicaid SME Required
  • Candidates with previous State Medicaid program experience will be given strong consideration.
  • Drug screen and background check required as part of onboarding
Position Summary
The Medicaid Business/QA Analyst serves as a subject matter expert (SME) for Medicaid data and processes while performing quality assurance testing within a large-scale Enterprise Data Warehouse (EDW) environment. This position combines program knowledge—eligibility, claims, encounters, provider enrollment, managed care, and reporting—with QA discipline to ensure accuracy, completeness, and usability of EDW deliverables such as data marts, inbound source data loads, outbound extracts, reporting outputs, and operational dashboards.
Key Responsibilities1. Business SME – Medicaid Data & Processes
  • Interpret Medicaid data elements, business rules, and program logic for EDW initiatives.
  • Review inbound data from core systems (eligibility, provider, claims, managed care) for accuracy and mapping alignment.
  • Validate outbound extracts and reporting outputs for accuracy, timeliness, and format requirements.
  • Support development of data marts across eligibility, claims/utilization, provider, managed care, LTSS, and behavioral health.
2. QA Planning & Execution
  • Develop QA plans, scenarios, and test cases aligned to business rules.
  • Perform data reconciliation between source files and EDW target tables.
  • Validate transformations, aggregations, and derived fields.
  • Participate in User Acceptance Testing (UAT) with business stakeholders.
3. Data Quality & Issue Resolution
  • Identify data anomalies, mapping issues, and business rule gaps; work with data engineering and ETL teams to resolve.
  • Ensure referential integrity across eligibility, claims, provider, and plan datasets.
  • Define business data quality rules for ongoing monitoring.
  • Track and document issues in defect management tools.
4. Collaboration & Documentation
  • Work with business stakeholders, vendors, and technical teams to validate requirements and deliverables.
  • Review BRDs, mapping documentation, and data models for accuracy.
  • Maintain QA evidence, testing documentation, and business rule records.
  • Support knowledge transfer related to Medicaid data usage within the EDW.
Required Skills & Qualifications
  • Strong Medicaid business knowledge (eligibility, claims, encounters, provider, managed care).
  • Experience working with EDW environments, including inbound feeds, staging layers, integration layers, data marts, and outbound extracts.
  • Proficiency with SQL for validation and reconciliation.
  • Experience in data warehouse QA/testing, including validating data transformations and dimensional models.
  • Ability to translate Medicaid program rules into testable acceptance criteria.
  • Familiarity with HIPAA compliance and PHI guidelines.
  • Excellent analytical, documentation, and communication skills.
Preferred Qualifications
  • Experience with Medicaid EDW or MMIS modernization projects.
  • Familiarity with provider handbooks, policy documentation, or administrative rules.
  • Experience with managed care data (capitation, encounters, member assignments).
  • Experience validating dashboards or reports in tools such as Tableau, Power BI, or Cognos.
  • Background in data governance or metadata management.