Director, Payment Integrity & Strategy

Molina Healthcare; Northern (KY); Hybrid; USD 88,000 - 190,000; Full time

Job summary

Molina Healthcare in the United States seeks a Director to lead the strategic development, governance, implementation, and optimization of the post-pay payment integrity concept portfolio. You will manage a team of Business Analysts focused on white papers, requirements, and enhancements, coordinating with Health Plans, Data Science, and executive leadership to achieve financial and operational goals.

You will oversee end-to-end lifecycle activities, drive continuous improvement, and ensure

Qualifications

• 8+ years of experience supporting health care operations, including 5+ years payment integrity/claims experience.
• 3+ years of management/leadership experience.
• Managed care payor experience, preferably in Medicare/Medicaid government-sponsored programs.
• Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and customers.
• Strong organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
• Excellent verbal and written communication skills.
• Microsoft Office suite proficiency.

Responsibilities

• Develop and execute the strategic roadmap for the post-pay payment integrity concept portfolio, ensuring alignment with organizational financial, operational, and regulatory objectives.
• Oversee the end-to-end lifecycle of payment integrity concepts, including intake, prioritization, requirements development, implementation, testing, deployment, maintenance, enhancement, and retirement.
• Champion and drive continuous improvement initiatives that enhance scalability, automation, productivity, and concept performance.
• Lead, mentor, and develop a team of Business Analysts responsible for concept white papers, business requirements, enhancement requests, and concept maintenance activities.
• Establish performance expectations, development plans, and succession strategies that support organizational growth and talent development.
• Ensure the accuracy, consistency, and governance of concept white papers, business requirements, operational specifications, and supporting documentation.

Skills

Leadership

Communication skills

Strategic planning

Project management

Regulatory knowledge

Tools

Microsoft Office

Job description

Molina Healthcare in the United States seeks a Director to lead the strategic development, governance, implementation, and optimization of the post-pay payment integrity concept portfolio. You will manage a team of Business Analysts focused on white papers, requirements, and enhancements, coordinating with Health Plans, Data Science, and executive leadership to achieve financial and operational goals.

You will oversee end-to-end lifecycle activities, drive continuous improvement, and ensure