He played college football for the Louisville Cardinals, and was selected by the Miami Dolphins in the second round of the 1997 NFL draft.
Madison attended Florida A&M University Developmental Research School where he played wide receiver and defensive back.
As a senior, he was named a second-team All-America and first-team All-Conference USA after finishing with 52 tackles, two sacks, six interceptions and 16 passes defensed.
For much of his career as a Miami Dolphin, Sam Madison played alongside fellow cornerback Patrick Surtain.
During their time together, Madison and Surtain were one of the most prolific cornerback tandems in NFL history, posting a combined 697 tackles, 7.5 sacks, 60 interceptions, and 2 touchdowns.
On February 18, 2022, the Miami Dolphins announced they hired Madison as their cornerbacks coach and pass game coordinator.