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Medicare Medicaid Program Integrity Manager Jobs in Ridgeway, SC

Gentiva

Patient Care Manager

Columbia, SC · On-site

$70 - $90/hr

... Medicare, Medicaid, JCAHO, ACHC) * Knowledge and compassion for terminally ill patients and their ... Wellness Programs (Telemedicine, Diabetes Management, Joint & Spine Concierge Care) * Education ...

New

Kids for the Future

Infusion RN

Columbia, SC · On-site

$70 - $90/hr

Our core values are Compassion , Integrity , Quality , Respect and Teamwork . You will be ... Medicare, Medicaid and commercial insurance. * Working knowledge of electronic medical record ...

Gentiva Hospice

Patient Care Manager

Columbia, SC · On-site

... Medicare, Medicaid, JCAHO, ACHC) * Knowledge and compassion for terminally ill patients and their ... Wellness Programs (Telemedicine, Diabetes Management, Joint & Spine Concierge Care) * Education ...

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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 Sep 7, 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 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.

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

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.

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 job categories do people searching Medicare Medicaid Program Integrity Manager jobs in Ridgeway, SC look for?

The top searched job categories for Medicare Medicaid Program Integrity Manager jobs in Ridgeway, SC are:

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 August 2026, with employment types broken down into 96% Full Time, and 4% Temporary. Highlights an 78% In-person, 4% Hybrid, and 18% Remote job distribution, with an average salary of $102,445 per year, or $49.3 per hour.

Administrative / Billing Specialist

Innovative Solutions Consulting & Counseling Group LLC

Columbia, SC • On-site

$17.75 - $24/hr

Full-time

Re-posted 12 days ago

Job description

The Administrative / Billing Specialist supports basic medical billing functions for a Counseling and Case Management agency, with entry-level exposure to counseling, case management coordination, opioid abatement support, and commercial health care credentialing. This role includes front-desk reception duties as needed and is suitable for individuals building experience in billing and care coordination.


Key goals:


  • Ensure accurate, timely submission of eligible institutional claims (UB-04/CMS-1450) within an entry-level scope.
  • Maintain orderly accounts receivable data and support routine payment posting.
  • Assist with credentialing-related tasks and basic care coordination support under supervision.


ESSENTIAL RESPONSIBILITIES AND DUTIES


  • Prepare, review, and submit basic institutional claims (UB-04/CMS-1450) to Medicare, Medicaid, and commercial payers via electronic submission under supervision.
  • Perform daily payment posting and basic AR aging updates; assist with reconciliation as directed.
  • Research and resubmit simple denied/rejected claims; escalate complex denials to more senior staff.
  • Provide entry-level case management coordination tasks as directed, focusing on identifying patient needs and facilitating access to services.
  • Support opioid abatement efforts by documenting needs and coordinating with care teams, under supervision, ensuring appropriate coding where applicable.
  • Assist with eligibility and authorization data gathering; collaborate with Clinical Documentation to support billed services as directed.
  • Collect and relay information for care coordination meetings and discharge planning as assigned.
  • Ensure compliance with CMS, state Medicaid, and commercial payer guidelines for routine claims; escalate potential compliance issues to supervisor.
  • Maintain awareness of current billing rules at a high level (basic revenue codes) and apply them within defined parameters.
  • Perform other administrative tasks and special projects as assigned.
  • ADDITIONAL RELEVANT DUTIES
  • Serve as a frontline receptionist as needed, including:
      Greeting visitors, answering calls, and routing inquiries.
      Scheduling basic appointments and maintaining a clean reception area.
  • Support cross-functional communication with Billing, Intake, Clinical Documentation, and Administration at a basic level.

QUALIFICATIONS & REQUIREMENTS

  • Typically 0–2 years of healthcare medical billing experience; exposure to Counseling or medical billing preferred but not required.
    Basic familiarity with ICD-10/CPT codes and institutional claim forms (UB-04/CMS-1450) is helpful.
    Interest or exposure to counseling, case management, opioid abatement, or credentialing support is a plus.
    Proficiency with basic computer systems; willingness to learn EHR/billing software.
    Strong attention to detail, organizational skills, and professional communication.

PREFERRED KNOWLEDGE AND SKILLS

  • Associate’s degree or equivalent in a related field (healthcare administration, business) preferred.
    Interest in medical billing, credentialing processes, or social services support.
    Strong communication and teamwork abilities.
    High level of professionalism and integrity with regulatory compliance awareness.

SUPERVISORY RESPONSIBILITIES

None.