Director of Payment Integrity & Analytics

Molina Healthcare, Inc.; United States; Remote; USD 190,000 - 270,000; Full time

Benefits offered by this job

Competitive benefits package

Job summary

Molina Healthcare, Inc. is seeking a Director to lead the strategy, governance, implementation, maintenance, and optimization of the organization’s post-pay data mining program for payment integrity.

You will direct a team of Business Analysts, Data Engineers and Data Analysts to translate reimbursement policies into scalable analytical solutions and to drive continuous improvement across markets.

Qualifications

• 8+ years of experience in health care operations and 5+ years in payment integrity/claims.
• 3+ years of management/leadership experience.
• Proven ability to coordinate across coworkers, providers, and customers.
• Strong organizational and time-management skills with multiple concurrent projects.
• Excellent verbal and written communication skills.
• Proficiency with Microsoft Office and related software.

Responsibilities

• Develop and execute the strategic roadmap for post-pay payment integrity concepts.
• Oversee end-to-end lifecycle of concepts with governance, methodology, and performance tracking.
• Provide technical oversight of SQL logic, Databricks, and Azure DevOps workflows.
• Lead enterprise projects driving financial improvement and operational transformation.
• Mentor a team of analysts and data engineers for research, development, and maintenance.
• Establish KPIs and reporting to communicate enterprise payment integrity outcomes.
• Represent Payment Integrity in governance and external discussions.
• Champion automation and data-driven decision-making.
• Set development plans and succession strategies to grow the team.
• Translate reimbursement policies and coding guidelines into actionable requirements.

Skills

Leadership

Communication

Time management

Tools

Databricks

Azure DevOps

SQL

Job description

Molina Healthcare, Inc. is seeking a Director to lead the strategy, governance, implementation, maintenance, and optimization of the organization’s post-pay data mining program for payment integrity.

You will direct a team of Business Analysts, Data Engineers and Data Analysts to translate reimbursement policies into scalable analytical solutions and to drive continuous improvement across markets.