Medicaid Program Integrity Investigator

Maryland AG; Baltimore, Northern (MD, KY); Hybrid; USD 70,000 - 110,000; Full time

Job summary

Maryland Office of the Inspector General for Health (OIGH) seeks a Regulatory Compliance Investigator to perform audits and investigations across Maryland’s Medicaid population. You will determine beneficiary eligibility, verify applications, and assess compliance with state and federal rules.

The role involves confidential investigations, coordination with multiple MDH units, and production of formal reports with enforceable recommendations. HIPAA and regulatory standards guide all activities.

Qualifications

• Seven years of experience developing or applying policies and regulations in medical assistance or health programs.
• Substitution options allow degrees or military service in related fields.
• Experience working with Medicaid or entitlement programs is preferred.

Responsibilities

• Investigate fraud, waste and abuse in Medicaid programs and determine eligibility.
• Perform audits and follow up reviews of MDH administrations and partner agencies.
• Prepare formal reports with recommendations for potential recovery or prosecutions.
• Ensure HIPAA and COMAR compliance in all activities.

Skills

Policy development

Regulatory compliance

Interviewing subjects

Information gathering

Education

Bachelor's degree substituted with 3 years relevant experience

Master's degree substitution for experience

Military service in health-related field (year-for-year) substitution

Job description

Maryland Office of the Inspector General for Health (OIGH) seeks a Regulatory Compliance Investigator to perform audits and investigations across Maryland’s Medicaid population. You will determine beneficiary eligibility, verify applications, and assess compliance with state and federal rules.

The role involves confidential investigations, coordination with multiple MDH units, and production of formal reports with enforceable recommendations. HIPAA and regulatory standards guide all activities.