Department Program Integrity Operations Job Summary * Investigate providers of various Medicaid programs to ensure expenditures are made in accordance with Federal and State regulations. * Process ...
Department Program Integrity Operations Job Summary * Investigate providers of various Medicaid programs to ensure expenditures are made in accordance with Federal and State regulations. * Process ...
Investigate providers of various Medicaid programs to ensure expenditures are made in accordance with Federal and State regulations. * Process and track all Medicaid provider and recipient related ...
Investigate providers of various Medicaid programs to ensure expenditures are made in accordance with Federal and State regulations. * Process and track all Medicaid provider and recipient related ...
Investigate providers of various Medicaid programs to ensure expenditures are made in accordance with Federal and State regulations. Process and track all Medicaid provider and recipient related ...
Investigate providers of various Medicaid programs to ensure expenditures are made in accordance with Federal and State regulations. Process and track all Medicaid provider and recipient related ...
Program Integrity Manager, Pennsylvania - Remote
Pittsburgh, PA · Remote
$91K - $163K/yr
The Program Integrity Manager is an individual contributor role responsible for fraud, waste and abuse and specific research leading to best practice policy implementation and vendor/subcontractor ...
Program Integrity Manager, Pennsylvania - Remote
Pittsburgh, PA · Remote
$91K - $163K/yr
The Program Integrity Manager is an individual contributor role responsible for fraud, waste and abuse and specific research leading to best practice policy implementation and vendor/subcontractor ...
The Program Integrity Specialist operates as the primary resource for investigations, prevention, and program audit-related activities. The specialist must understand key business objectives and ...
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The Program Integrity Specialist operates as the primary resource for investigations, prevention, and program audit-related activities. The specialist must understand key business objectives and ...
Work with applicable program management staff, contract staff and other staff from agencies involved in case reviews and investigations. * Research and discern pertinent information from Medicaid ...
Work with applicable program management staff, contract staff and other staff from agencies involved in case reviews and investigations. * Research and discern pertinent information from Medicaid ...
Program Integrity SURS Clinician
$52K - $69K/yr
Work with applicable program management staff, contract staff and other staff from agencies involved in case reviews and investigations. * Research and discern pertinent information from Medicaid ...
Program Integrity SURS Clinician
$52K - $69K/yr
Work with applicable program management staff, contract staff and other staff from agencies involved in case reviews and investigations. * Research and discern pertinent information from Medicaid ...
SME - Medicaid Program Integrity and Claims Audits
$120K - $140K/yr
Ensure the Medicaid program integrity policies and procedures meet federal and state policies and grants compliance. * Research Medicaid policies and regulations. * Advise and assist clients in ...
SME - Medicaid Program Integrity and Claims Audits
$120K - $140K/yr
Ensure the Medicaid program integrity policies and procedures meet federal and state policies and grants compliance. * Research Medicaid policies and regulations. * Advise and assist clients in ...
SME - Medicaid Program Integrity and Claims Audits
$120K - $140K/yr
Ensure the Medicaid program integrity policies and procedures meet federal and state policies and grants compliance. * Research Medicaid policies and regulations. * Advise and assist clients in ...
SME - Medicaid Program Integrity and Claims Audits
$120K - $140K/yr
Ensure the Medicaid program integrity policies and procedures meet federal and state policies and grants compliance. * Research Medicaid policies and regulations. * Advise and assist clients in ...
Program Integrity SURS Clinician
Baton Rouge, LA · On-site
$52K - $69K/yr
Work with applicable program management staff, contract staff and other staff from agencies involved in case reviews and investigations. * Research and discern pertinent information from Medicaid ...
Program Integrity SURS Clinician
Baton Rouge, LA · On-site
$52K - $69K/yr
Work with applicable program management staff, contract staff and other staff from agencies involved in case reviews and investigations. * Research and discern pertinent information from Medicaid ...
Program Integrity SURS Clinician
Baton Rouge, LA · On-site
$52K - $69K/yr
Work with applicable program management staff, contract staff and other staff from agencies involved in case reviews and investigations. Research and discern pertinent information from Medicaid ...
Program Integrity SURS Clinician
Baton Rouge, LA · On-site
$52K - $69K/yr
Work with applicable program management staff, contract staff and other staff from agencies involved in case reviews and investigations. Research and discern pertinent information from Medicaid ...
Medicaid Payment Integrity SME
Kapolei, HI · On-site +1
You will provide oversight and management of day-to-day operation of program integrity activities including claims audits, forensic reviews, investigations, documentation of findings, case tracking ...
Medicaid Payment Integrity SME
Kapolei, HI · On-site +1
You will provide oversight and management of day-to-day operation of program integrity activities including claims audits, forensic reviews, investigations, documentation of findings, case tracking ...
You will provide oversight and management of day-to-day operation of program integrity activities including claims audits, forensic reviews, investigations, documentation of findings, case tracking ...
You will provide oversight and management of day-to-day operation of program integrity activities including claims audits, forensic reviews, investigations, documentation of findings, case tracking ...
Medicaid Payment Integrity SME
Kapolei, HI · On-site +1
You will provide oversight and management of day-to-day operation of program integrity activities including claims audits, forensic reviews, investigations, documentation of findings, case tracking ...
Medicaid Payment Integrity SME
Kapolei, HI · On-site +1
You will provide oversight and management of day-to-day operation of program integrity activities including claims audits, forensic reviews, investigations, documentation of findings, case tracking ...
Job Summary This position is under the general guidance of the Director, Program Integrity and reports directly to the Supervisor, Program Integrity. The PI Investigator t is responsible for the ...
Job Summary This position is under the general guidance of the Director, Program Integrity and reports directly to the Supervisor, Program Integrity. The PI Investigator t is responsible for the ...
Program Manager
Washington, DC · On-site +1
$169K - $197K/yr
Direct administrative program integrity reviews involving potential fraud, waste, abuse, improper payments, control weaknesses, and other program integrity risks affecting Federal health benefits ...
Program Manager
Washington, DC · On-site +1
$169K - $197K/yr
Direct administrative program integrity reviews involving potential fraud, waste, abuse, improper payments, control weaknesses, and other program integrity risks affecting Federal health benefits ...
Program Manager
Washington, DC · On-site +1
$169K - $197K/yr
Direct administrative program integrity reviews involving potential fraud, waste, abuse, improper payments, control weaknesses, and other program integrity risks affecting Federal health benefits ...
Program Manager
Washington, DC · On-site +1
$169K - $197K/yr
Direct administrative program integrity reviews involving potential fraud, waste, abuse, improper payments, control weaknesses, and other program integrity risks affecting Federal health benefits ...
Medical Review Manager-Program Integrity ( RN, BSN, or MSN required )
Annapolis Junction, MD · On-site
The Medical Review Manager, Program Integrity is the senior clinical operations leader for the Fraud Investigations Group support workstream, responsible for overseeing all CMS directed Program ...
Medical Review Manager-Program Integrity ( RN, BSN, or MSN required )
Annapolis Junction, MD · On-site
The Medical Review Manager, Program Integrity is the senior clinical operations leader for the Fraud Investigations Group support workstream, responsible for overseeing all CMS directed Program ...
This position will provide subject matter expertise in Medicaid program integrity, claims audits, risk assessment, external audit coordination, interpretation and application of Medicaid policy and ...
This position will provide subject matter expertise in Medicaid program integrity, claims audits, risk assessment, external audit coordination, interpretation and application of Medicaid policy and ...
Payment Integrity Subject Matter Expert (SME)
Kapolei, HI · On-site
$95 - $120/hr
This position will provide subject matter expertise in Medicaid program integrity, claims audits, risk assessment, external audit coordination, interpretation and application of Medicaid policy and ...
Payment Integrity Subject Matter Expert (SME)
Kapolei, HI · On-site
$95 - $120/hr
This position will provide subject matter expertise in Medicaid program integrity, claims audits, risk assessment, external audit coordination, interpretation and application of Medicaid policy and ...
Program Integrity information
See salary details
$25K - $31K
4% of jobs
$31K - $36.9K
12% of jobs
$39.3K is the 25th percentile. Wages below this are outliers.
$36.9K - $42.9K
22% of jobs
The median wage is $46.3K / yr.
$42.9K - $48.8K
20% of jobs
$48.8K - $54.8K
13% of jobs
$57.1K is the 75th percentile. Wages above this are outliers.
$54.8K - $60.7K
10% of jobs
$60.7K - $66.7K
6% of jobs
$66.7K - $72.6K
5% of jobs
$72.6K - $78.6K
3% of jobs
$78.6K - $84.5K
2% of jobs
$84.5K - $90.5K
2% of jobs
$25K
$52.4K
$90.5K
How much do program integrity jobs pay per year?
What is a program integrity job?
What are some common challenges faced in a program integrity role, and how can they be effectively managed?
What are the key skills and qualifications needed to thrive in a program integrity role, and why are they important?
What is the difference between Program Integrity vs Claims Analyst?
| Aspect | Program Integrity | Claims Analyst |
|---|---|---|
| Required Credentials | Typically requires a bachelor’s degree in healthcare, public health, or related fields; certifications like Certified Professional Coder (CPC) may be beneficial | Usually requires a bachelor’s degree in finance, healthcare administration, or related fields; certifications like Certified Claims Professional (CCP) are common |
| Work Environment | Government agencies, insurance companies, healthcare organizations focusing on compliance and fraud detection | Insurance companies, healthcare providers, or third-party administrators analyzing claims data |
| Employer & Industry Usage | Primarily in healthcare, insurance, and government sectors for compliance and fraud prevention | In insurance and healthcare sectors for processing and analyzing claims |
Program Integrity professionals focus on preventing fraud, waste, and abuse in healthcare programs, ensuring compliance with regulations. Claims Analysts primarily review and process insurance claims, verifying accuracy and eligibility. While both roles work within healthcare and insurance industries, Program Integrity emphasizes compliance and fraud detection, whereas Claims Analysts concentrate on claims processing and data analysis.
What cities are hiring for Program Integrity jobs?
Cities with the most Program Integrity job openings:
What are the most commonly searched types of Program Integrity jobs?
The most popular types of Program Integrity jobs are:
What states have the most Program Integrity jobs?
States with the most job openings for Program Integrity jobs include:

Full-time
Re-posted 15 days ago
Job description
Thank you for your interest in The University of New Orleans.
Once you start the application process, you will not be able to save your work, so you should collect all required information before you begin. The required information is listed below in the job posting.
You must complete all required portions of the application and attach the required documents in order to be considered for employment.
Department
Program Integrity OperationsInvestigate providers of various Medicaid programs to ensure expenditures are made in accordance with Federal and State regulations.
Process and track all Medicaid provider and recipient related complaints reported via email, the Medicaid Fraud website or internally.
Interacts with varies internal and external entities such as Medicaid recipients, Medicaid providers, LDH program operations, licensing boards, the Attorney General's office, etc.
Document findings of investigations initiated by referrals from Medicaid programs including but not limited to OAAS, Behavioral Health, Provider Enrollment, MFCU and Plans.
Detail any corrective action(s) necessary after conducting a comprehensive case review of findings.
Ensure all providers are furnished with a written notification of any corrective actions and cite the applicable Medicaid/LaCHIP policy reference.
Assist in maintaining records of provider fraud, waste and abuse referrals for investigation.
Maintain findings and results on fraud referrals received within the centralized tracking system.
Conducts research on all policy violations and corrective action.
Maintains and assists with up-to-date reporting statistics and data for unit reports.
Notify management of any trends that are a direct cause of or contributing factor to errors that come to light during the review process or while tracking all cases received for review.
Refer applicable cases to the Office of the Attorney General.
Prepare written summary report with all relevant background facts.
Provide any assistance needed to the legal authority.
May be called upon as a witness to a case once it proceeds to trial.
Complete special projects as directed by management.
QUALIFICATIONS
REQUIRED:
Bachelor's Degree, or Associates degree with 3 years professional experience, or 6 years professional experience in lieu of the degree.
Excellent analytical skills, effective organizational and time management skills.
Excellent verbal and written communications skills.
Proficient in the use of Microsoft Office, including but not limited to Outlook, Word, and Excel.
DESIRED:
Advanced degree.
2 years professional experience in provider enrollment and credentialing.
1 year professional experience with Louisiana Medicaid policy and procedures.
Experience with Electronic Visit Verification.
Experience with data analysis and report development.
SALARY: 37-47k
Required Attachments
Please upload the following documents in the Resume/Cover Letter section.
- Detailed resume listing relevant qualifications and experience;
- Cover Letter indicating why you are a good fit for the position and University of Louisiana Systems;
- Names and contact information of three references;
Applications that do not include the required uploaded documents may not be considered.
Note to Applicant:
Applicants should fully describe their qualifications and experience with specific reference to each of the minimum and preferred qualifications in their cover letter. The search committee will use this information during the initial review of application materials.
References will be contacted at the appropriate phase of the recruitment process.
This position may require a criminal background check to be conducted on the candidate(s) selected for hire.
As part of the hiring process, applicants for positions at the University of New Orleans may be required to demonstrate the ability to perform job-related tasks.
The University of New Orleans is an Affirmative Action and Equal Employment Opportunity employer. We do not discriminate on the basis of race, gender, color, religion, national origin, disability, sexual orientation, gender identity, protected Veteran status, age if 40 or older, or any other characteristic protected by federal, state, or local law.
About University of New Orleans
Sourced by ZipRecruiter
Industry
Colleges, universities, and professional schools
Company size
1,001 - 5,000 Employees
Headquarters location
New Orleans, LA, US
Year founded
1958