Lead, Payment Integrity & Recovery Operations

Molina Healthcare; United States; Remote; USD 66,000 - 143,000; Full time

Job summary

Molina Healthcare seeks a leader to manage payment integrity operations, driving accuracy, timely delivery, and adherence to policy. You will develop staff, monitor performance metrics, and collaborate with shared services to resolve issues impacting payment precision.

The role emphasizes process improvement, data accuracy, and cost avoidance, with opportunities to lead small to mid-scale projects and advance professional growth within a team-focused environment.

Qualifications

• 7+ years of experience supporting health care operations, including 4 years in payment integrity/claims.
• At least 1 year of management/leadership experience.
• Strong verbal and written communication skills.

Responsibilities

• Leads and manages day-to-day operations for assigned payment integrity programs, ensuring accuracy, timeliness, and adherence to policies and procedures.
• Hires, trains, and develops staff responsible for inventory management, reporting, data integrity, and recovery performance.
• Implements and monitors quality assurance programs and performance metrics to ensure recovery and cost avoidance targets are met.
• Collaborates with internal departments to resolve system or process issues impacting payment accuracy.
• Reviews and refines workflows and standard operating procedures to improve efficiency, accuracy, and audit readiness.
• Facilitates meetings with vendors and internal partners to discuss production performance, operational barriers, and process optimization opportunities.
• Analyzes operational data to identify trends, evaluate recovery effectiveness, and propose actionable improvements.
• Supports compliance with CMS and state regulations.
• Contributes to small- to mid-scale projects focused on process improvement, automation, and data accuracy.
• Promotes a culture of accountability, continuous improvement, and professional development within the team.

Skills

Leadership

Attention to detail

Communication skills

Time management

Tools

Microsoft Office

Job description

Molina Healthcare seeks a leader to manage payment integrity operations, driving accuracy, timely delivery, and adherence to policy. You will develop staff, monitor performance metrics, and collaborate with shared services to resolve issues impacting payment precision.

The role emphasizes process improvement, data accuracy, and cost avoidance, with opportunities to lead small to mid-scale projects and advance professional growth within a team-focused environment.