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Medicare Medicaid Program Integrity Manager Jobs

CVS Health

Program Integrity Manager

New York, NY

$54K - $145K/yr

Position Summary The Program Integrity Manager serves as a key leader supporting Medicaid Program Integrity, Payment Integrity, and Special Investigations Unit (SIU) activities. This role is ...

BerryDunn

Program Integrity Lead

This role will lead Medicaid program integrity activities related to fraud, waste, and abuse ... Medicaid initiatives preferred. * Experience managing complex projects involving multiple ...

New

BerryDunn

This role will lead Medicaid program integrity activities related to fraud, waste, and abuse ... Medicaid initiatives preferred. * Experience managing complex projects involving multiple ...

BerryDunn

$95K - $130K/yr

Interpret Medicaid regulatory, Program Integrity, Third-Party Liability (TPL), Payment Error Rate ... Support responses to Centers for Medicare & Medicaid Services (CMS), state, or stakeholder requests ...

Barrow Wise Consulting

Medicaid/Medicare Consultant

MD · On-site

$90K - $150K/yr

Provide and manage consulting, data transfer, and claims processing services to increase federal ... billing Medicare Part A & B and Medicaid programs; provide IDHS with detailed information ...

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$38.5K

$107.5K

$157K

How much do medicare medicaid program integrity manager jobs pay per year?

As of Jul 29, 2026, the average yearly pay for medicare medicaid program integrity manager in the United States is $107,460.00, according to ZipRecruiter salary data. Most workers in this role earn between $79,500.00 and $132,500.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Medicare Medicaid Program Integrity Manager, and why are they important?

To thrive as a Medicare Medicaid Program Integrity Manager, you need expertise in healthcare compliance, fraud detection, regulatory policy, and a bachelor's degree in healthcare administration or a related field. Familiarity with data analytics tools, case management systems, and regulatory databases such as CMS is typically required, along with certifications like Certified Professional in Healthcare Quality (CPHQ) or Certified Fraud Examiner (CFE). Strong analytical thinking, leadership, and effective communication skills are essential for coordinating investigations and collaborating with stakeholders. These skills and qualifications are crucial for upholding program integrity, minimizing fraud and abuse, and ensuring adherence to government healthcare regulations.

What does a Medicare Medicaid Program Integrity Manager do?

A Medicare Medicaid Program Integrity Manager is responsible for overseeing efforts to prevent, detect, and address fraud, waste, and abuse within Medicare and Medicaid programs. They develop and manage compliance strategies, conduct audits and investigations, and ensure that healthcare providers and beneficiaries follow federal and state regulations. Their work helps protect public funds and maintain the integrity of government healthcare programs.

How does a Medicare Medicaid Program Integrity Manager typically collaborate with compliance teams and federal auditors?

A Medicare Medicaid Program Integrity Manager regularly works alongside compliance teams to develop and implement processes that detect and prevent fraud, waste, and abuse in government healthcare programs. They also serve as a key liaison during audits and investigations conducted by federal agencies, ensuring that all requested documentation is accurate and submitted promptly. Frequent communication and coordination with both internal teams and external auditors are essential, as these partnerships help maintain program integrity and regulatory compliance.
More about Medicare Medicaid Program Integrity Manager jobs
What cities are hiring for Medicare Medicaid Program Integrity Manager jobs? Cities with the most Medicare Medicaid Program Integrity Manager job openings:
What states have the most Medicare Medicaid Program Integrity Manager jobs? States with the most job openings for Medicare Medicaid Program Integrity Manager jobs include:
What job categories do people searching Medicare Medicaid Program Integrity Manager jobs look for? The top searched job categories for Medicare Medicaid Program Integrity Manager jobs are:
Medicare Medicaid Program Integrity Manager jobs near you
Infographic showing various Medicare Medicaid Program Integrity Manager job openings in the United States as of July 2026, with employment types broken down into 83% Full Time, 15% Part Time, and 2% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $107,460 per year, or $51.7 per hour.

Medicaid/Medicare Program Integrity Analyst II

CoventBridge Group

Remote

$58K - $70K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 6 days ago

CoventBridge Group rating

6.7

Company rating: 6.7 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

302nd of 488 rated business services

Job description

Overview
Medicaid/Medicare Program Integrity Analyst II - REMOTE
The Medicaid/Medicare Program Integrity Analyst II performs evaluation and development of leads, complaints, and/or investigations to verify allegations of potential fraud. Recommends and/or implements appropriate administrative actions.
In assuming this position, you will be a critical contributor to meeting CoventBridge Integrity Systems' objective: To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse.
This position will report directly to the Program Integrity Supervisor and will work in our Grove City, OH office, or if not local, remotely from a home office.
Responsibilities/ Requirements
Responsibilities:
  • Perform evaluation and development of leads, complaints, and/or investigations to determine if further investigation and administrative actions are warranted
  • Conduct independent reviews resulting from the discovery of situations that potentially involve fraud or abuse
  • Utilize basic data analysis techniques to detect aberrancies in Medicare and Medicaid claims data, and proactively seeks out and develops leads/investigations received from a variety of sources (e.g., CMS, OIG, 1-800-MEDICARE, and fraud alerts)
  • Review information contained in standard claims processing system files (e.g., claims history, provider files) to determine provider billing patterns and to detect potential fraudulent or abusive billing practices or vulnerabilities in Medicare and Medicaid policies and initiate appropriate action
  • Make potential fraud determinations by utilizing a variety of sources such as internal guidelines, Medicare and Medicaid provider manuals, Medicare and Medicaid regulations, and the Social Security Act
  • Compile and maintain documentation and information related to investigations, cases, and/or leads
  • Participate in onsite audits in conjunction with investigation development
  • Develop and prepare potential Fraud Alerts and program vulnerabilities for submission to CMS. Share information on current fraud investigations with other Medicare contractors and state Medicaid agencies, law enforcement, and other applicable stakeholders
  • Prepare and submit external correspondence and reports, including, but not limited to, overpayment letters, fraud case referrals, suspensions, rebuttals, Medicare/Medicaid findings reports, and administrative action recommendations
  • Submit suspension notifications to providers upon suspension approval
  • Prepare and submit ADR letters to providers associated with requests for medical record requests or suspension overpayment determinations
  • Serve as mentor/trainer to new Program Integrity staff
  • Perform other duties as assigned by PI Supervisor or PI Manager that contribute to task order goals and objectives

Requirements:
  • Excellent research and organization, prioritization, and time management skills
  • Excellent verbal and written communication skills
  • Ability to work independently with minimal supervision
  • Ability to multi-task in a fast-paced environment
  • Knowledge of statistics, data analysis techniques, and PC skills are preferred

Educational/Experience Qualifications:
  • High School Diploma or G.E.D. equivalent, with preference given to those candidates who have successfully completed college or technical degree programs related to the position (e.g., Criminal Justice, Statistics, Data Analysis, etc.)
  • Candidates with Certified Fraud Examiner (CFE) Certifications will be given priority consideration
  • At least 1 year of experience in Program Integrity investigation/detection or a related field that demonstrates expertise in reviewing, analyzing/developing information, and making appropriate decisions

Benefits
  • Medical, Dental, Vision plans
  • Life, LTD and STD paid by the employer
  • 401(k) with company match up to 4%
  • Paid Time Off and company paid holidays
  • Tuition assistance after 1 year of service

The salary range for this role is $58,000 to $70,000 annually. This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
At this time, CoventBridge is not considering candidates who require visa sponsorship, currently or in the future, including but not limited to H-1B, H-2B, E-3, TN, O-1, F-1 (OPT/CPT, or J-1 Visa Statuses.)
About Us:
CoventBridge Integrity Systems delivers investigative services, technology, and expertise that help healthcare and government organizations protect critical programs, strengthen oversight, and address fraud, waste, abuse, and operational risk.
CoventBridge Integrity Systems is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics and maintains a drug-free workplace.
CoventBridge Integrity Systems is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge Integrity Systems will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; 888-932-7364; humanresources@coventbridge.com.

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