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Medicare Medicaid Program Integrity Manager Jobs in Ridgeway, SC

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Health Care Analyst (Medicare)

Columbia, SC · Remote

Who is currently in Medicare/ Medicaid! Who holds 2+ years Program management, full lifecycle project, SDLC, Agile, Waterfall, SCRUM experience! Who holds 2 years experience with Medicare systems and ...

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All JobsMedicare Medicaid Program Integrity JobsMedicare Medicaid Program Integrity Manager JobsMedicare Medicaid Program Integrity Manager Jobs in Ridgeway, SC

Medicare Medicaid Program Integrity Manager information

See Ridgeway, SC salary details

$36.7K

$102.4K

$149.7K

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 Ridgeway, SC is $102,445.00, according to ZipRecruiter salary data. Most workers in this role earn between $75,800.00 and $126,300.00 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.
What cities near Ridgeway, SC are hiring for Medicare Medicaid Program Integrity Manager jobs? Cities near Ridgeway, SC with the most Medicare Medicaid Program Integrity Manager job openings:
Medicare Medicaid Program Integrity Manager jobs near you
Infographic showing various Medicare Medicaid Program Integrity Manager job openings in Ridgeway, SC as of July 2026, with employment types broken down into 81% Full Time, 16% Part Time, and 3% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $102,445 per year, or $49.3 per hour.

Senior Healthcare IT Business Analyst (Clinical & Coding Specialist) - HYBRID (MUST be a SC Resident

Chandra Technologies, Inc.

Columbia, SC • On-site

$70K - $93K/yr

Other

This job post has expired today. Applications are no longer accepted.

Job description

Job Description:

***Only W2 resumes are accepted

This project is a multi-year-old effort which primarily focuses on providing consulting services to operations and policy staff for the current Medicaid Management Information System (MMIS).

The current position’s focus and priority is the continued support of serving as a subject matter expert (SME), building knowledge that allows policy and process owners to make the best recommendations for Medicaid members and providers.

DAILY DUTIES / RESPONSIBILITIES:

The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance. As the IT Healthcare Consultant – Business Analyst – Advanced (Clinical Analyst and Coding Specialist):

Specific duties include, but are not limited to:

  • Initiates annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes.
  • Performs initial review of codes to determine scope of changes.
  • Prepares listings of codes changes to Reference Administration staff and Medicaid Program staff for review and analysis.
  • Conducts meetings with Agency personnel, stakeholders, and process owners.
  • (Future) Participates in DASH (Replacement MMIS) project meetings, as needed, where reference administration expertise is required.
  • Serves as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics.
  • Research business rules, requirements, and models to complete initial analysis and recommendations.
  • Maintains business rules, requirements, and models in a repository.
  • Collaborates with team to ensure process documentation is complete, owner and stakeholder, as needed, training content is complete and routinely updated.
  • May serve as a back-up to review patient records against established criteria to determine medical necessity.
  • Other project-related duties.

Required Skills

  • 10+ years in healthcare insurance; medical review, program integrity, or appeals.
  • 5+ years working with IT developers/programmers in a payor environment.
  • 5+ years Medical Coding in payer environment.
  • 3+ years clinical experience in a healthcare environment (strong clinical assessment and critical thinking skills.)
  • 5+ years knowledge of ICD/CPT/HCPCS translation and coding methodologies.
  • 5+ years knowledge of anatomy, physiology, pharmacology, and medical terminology.
  • Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)

Preferred Skills

  • 5+ years’ experience in policy remediation.
  • 5+ years claims processing systems experience.
  • 5+ years knowledge of Microsoft Office
  • 5+ years Optum Encoder and/or other medical coding software programs

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