Senior Consultant (Program Integrity Operations Supervisor) / 60019070

Senior Consultant (Program Integrity Operations Supervisor) / 60019070

Salary

$58,854.00 - $65,000.00 Annually

Location

Richland County, SC

Job Type

FTE - Full-Time

Job Number

190667

Agency

Department of Health and Human Services

Division

Operations and Managed Care

Opening Date

09/03/2026

Closing Date

9/9/2026 11:59 PM Eastern

Class Code:

AH42

Position Number:

60019070

Normal Work Schedule:

Monday - Friday (8:30 - 5:00)

Pay Grade

GEN10

Hiring Range - Min.

$58,854.00

Hiring Range - Max.

$65,000.00

EEO Statement

Equal Opportunity Employer

Agency Specific Application Procedures:

Failure to provide detailed and complete information may result in your application not being referred.

Veteran Preference Statement

South Carolina is making our Veterans a priority for employment in state agencies and institutions.

• Description
• Benefits
• Questions

Job Responsibilities

The Agencys mission is to be boldly innovative in improving the health and quality of life for South Carolinians.

This position is located the Operations and Managed Care Oversight, Richland County.

This is an in-office role and not a telecommute or remote position.

Are you the One? We are looking for a Program Integrity Operations Supervisor, who will assists with providing mid-level operational leadership and coordination across all PI operational functions within the Operations and Managed Care Oversight (OMCO) unit. This position executes, organizes, and monitors key responsibilities, including financial reconciliation, managed care oversight activities, enforcement workflows, audit documentation, data validation, trend integration, and hearings support, ensuring these functions comply with federal and state Medicaid PI requirements.

The PI Operations Supervisor translates strategic direction from the OMCO Manager into actionable work plans, maintains workflow continuity, ensures accuracy of PI documentation, and coordinates cross unit activities that support audit readiness, managed care obligations, and enforcement actions. The role serves as the central operational hub for OMCO, ensuring efficient daily execution of PI activities while maintaining clear communication with the OMCO Manager regarding priorities, risks, barriers, and performance needs.

• Coordinates daily operational activities across OMCO PI functions, including managed care oversight, financial integrity tasks, provider sanction actions, and case management workflows. Assigns tasks to PI coordinators, monitors progress, maintains operational calendars, and ensures timely completion of deliverables. Escalates emerging risks or barriers to the OMCO Manager with proposed solutions.
• Completes monthly PI financial reconciliation processes, validating recovery data across fee for service, managed care, Recovery Audit Contractor recoveries, global settlements, cost avoidance, and federal share requirements. Ensures all recoveries are accurately entered into the PI case management system and reconciled against Surveillance and Utilization Review and Accounting Operations reports. Produces monthly activity reports and supports fiscal documentation for audits.
• Administers the provider payment suspension process in accordance with the PI Payment Suspension policy. Maintains and updates the Payment Suspension SharePoint List and ensures accurate and timely execution of all system updates related to initiating or lifting provider payment suspensions. This function ensures adherence to federal regulations regarding provider suspension actions and minimizes improper payments to high-risk providers.
• Reviews federally sourced exclusion data through the Office of Inspector General (OIG) Extract Report, including information from the List of Excluded Individuals and Entities (LEIE) and the System for Award Management (SAM). Compares federal exclusion data with the Data Exchange (DEX) Adverse Report to identify potential provider matches. Refers confirmed matches to the Provider Sanctions Coordinator for further review and potential sanctions action. This process ensures compliance with federal exclusion screening requirements and prevents prohibited providers from receiving Medicaid reimbursement.
• Conducts compliance reviews of payments issued to providers, individuals, or entities that have been excluded or terminated from Medicaid participation. Identifies improper payments and ensures appropriate corrective actions are initiated to prevent sanctioned providers from receiving reimbursement. Coordinates with internal teams and external partners to support the recoupment of payments issued in error and maintains alignment with PI requirements. This function directly mitigates improper payment risk and supports federally required post-sanction monitoring.
• Assembles, validates, and organizes documentation for federal, state, contractual, and internal audits involving PI and MCO Special Investigative Units (SIUs). Maintains audit repositories, tracking logs, versioning, and submission coordination. Drafts corrective action plan (CAP) materials and ensures documentation consistency across sanctions, managed care, and financial teams.
• Maintains, tracks, and updates global and civil case files to support PI operations. Coordinates the collection and distribution of case-related documentation, including data requests, receipts, and accounts receivable materials. Works collaboratively with the Provider Overpayment Coordinator to ensure accurate and timely processing of financial documentation associated with these cases. This work supports federal settlement management, audit preparation, and accurate financial tracking.
• Oversight of Prehearing Conference and provider Fair Hearing material preparation, including assembling required documentation, reviewing and finalizing scripts, and coordinating timely scheduling with all applicable personnel. Ensure all required materials are complete and ready for use.
• Supports updates to PI internal policies. Reviews drafts, tracks revisions, ensures consistency, and maintains documentation repositories.
• Responsible for performing other professional duties as assigned by the OMCO Manager. Serves as a subject matter resource related to program development and/or other program area development when related to PI operations. Supports agency adaptability and responsiveness to emerging federal and state PI requirements.
• Enrollment and attendance in any training to provide knowledge regarding program integrity, MCO management, creative writing, or fraud, waste, and abuse. Ongoing training is essential to maintain current knowledge of evolving CMS guidance, federal regulations, audit expectations, and best practices in PI operations.

The South Carolina Department of Health and Human Services offers an exceptional benefits package for FTE and TGE positions that includes:

• Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
• 15 days annual (vacation) leave per year.
• 15 days sick leave per year.
• 13 paid holidays.
• State Retirement Plan and Deferred Compensation Programs.

Minimum and Additional Requirements

A bachelor's degree and two (2) years of professional experience in administrative or financial services, public administration or business management.

An equivalent combination of education and experience may be considered with prior State Human Resources approval. All degrees must be from a college or higher education institution recognized by the U.S. Department of Education & Council for Higher Education Accreditation (CHEA).

Additional Requirements:

• Valid drivers license.
• Occasional overnight travel.
• Overtime and/or weekend work with Deputy approval.
• Sitting or standing for long periods of time
• Lifting requirements: 20 lbs.
• In-office role.

Preferred Qualifications

• Preferred qualifications include experience in Medicaid Program Integrity (PI) operations such as managed care oversight, financial reconciliation, and sanctions; knowledge of federal and state Medicaid requirements; and strong analytical and organizational skills.
• Candidates should be proficient with case management and documentation tools like SharePoint and able to prepare reports, manage workflows, and support audit and hearing activities.
• Training or coursework related to PI, fraud, waste, and abuse, Medicaid operations, or managed care is also preferred.

Additional Comments

Please complete the State application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purposes. All applicants must apply online. All correspondence from the Office of Human Resources will be through electronic mail.

The South Carolina Department of Health and Human Services is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth or related medical conditions, including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.

Benefits for State Employees

The state of South Carolina offers eligible employees generous benefits, including health and dental insurance; retirement and savings plan options; and paid vacation and sick leave. Plus, work-life balance programs such as telecommuting and flexible work schedules are available to employees of some state agencies.

Insurance Benefits

Eligible employees may enroll in health insurance, which includes prescription coverage and wellness benefits. Other available insurance benefits include dental, vision, term life insurance, long term disability and flexible spending accounts for health and child care expenses.

Retirement Benefits

State employees are also offered retirement plan options, including defined benefit and defined contribution plans. Additionally, eligible employees may elect to participate in the South Carolina Deferred Compensation Program, which is a voluntary, supplemental retirement savings plan offering 401(k) and 457 plan options.

Workplace Benefits

State employees may also be eligible for other benefits, including tuition assistance; holiday, annual and sick leave; and discounts on purchases, travel and more.

Note: The benefits above are available to most state employees, with the exception of those in temporary positions. Employees in temporary grant and time-limited positions may be eligible for all, some or none of these benefits as benefits are associated with each position type. For these positions, contact the hiring agency to determine what benefits may be available.

01

The responses you provide to these Supplemental Questions will be used in combination with your application to determine whether you meet the minimum qualification requirements. Please, thoroughly complete the Education and Work Experience sections of your application and the Supplemental Questions. Failure to provide detailed and complete information will result in your application being rejected. Any misrepresentation or omissions will result in your disqualification from employment and/or termination. You may not submit resumes in lieu of filling out the application or answering the Supplemental Questions. I acknowledge that I have read, understand, and agree with the above.

• Yes
• No

02

The established hiring range for this position is $58,854 to $65,000. Do you accept this range?

• Yes
• No

03

Do you have a bachelors degree or higher?

• Yes
• No

04

Do you have at least two (2) years of professional experience in administrative or financial services, public administration or business management?

• Yes
• No

05

Do you have a valid drivers license? If yes, please provide your drivers license number and state of issuance.

06

Do you wish to claim Veteran Preference? If yes, you must submit a copy of your DD214 Form with your job application in order to qualify and claim this preference.

• Yes
• No

07

How did you hear about this career opportunity?

Required Question

Employer State of South Carolina

Agency Department of Health and Human Services Address 1801 Main Street, Suite 224

Columbia, South Carolina, 29201

Phone 803-898-2670

The language used in this document does not create an employment contract between the employee and the agency. This document does not create any contractual rights or entitlements. The agency reserves the right to revise the content of this document, in whole or in part. No promises or assurances, whether written or oral, which are contrary to or inconsistent with the terms of this paragraph create any contract of employment.