Manager, Payment Integrity Enablement

IEHP

Rancho Cucamonga (CA)

On-site

USD 104,000 - 138,000

Full time

2 days ago

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Benefits offered by this job

Competitive salary

On-site fitness center

Medical insurance

Life insurance

Career advancement

Wellness programs

Flexible Spending Account

CalPERS retirement

457(b) option

Paid life insurance for employees

Pet care insurance

Job summary

IEHP is seeking a Manager of Payment Integrity Enablement in Rancho Cucamonga. This role involves strategic leadership in payment accuracy education and compliance interventions.

The ideal candidate must have 7+ years of experience, a relevant bachelor’s degree, and certifications like CPC. The position also offers a competitive salary and various benefits such as a fitness center, medical insurance, and wellness programs.

Qualifications

7+ years of experience in healthcare payment integrity or related fields.
Prior leadership experience in mentoring or training required.
Valid California Driver's license mandatory.

Responsibilities

Provide strategic leadership over payment accuracy education.
Collaborate with cross-functional teams to ensure compliance.
Drive risk area identification and support coding accuracy.

Skills

Healthcare payment integrity

Revenue cycle management

Fraud, waste, and abuse prevention

ICD-10/CPT coding

Project leadership

Analytical skills

Communication skills

Microsoft Office Suite

SQL

Education

Bachelor's degree in healthcare administration or related field

Master's degree in healthcare administration or related field

Certification such as CPC or CHA

Job description

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an

authentic experience!

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an

authentic experience!

Reporting to the Director of Payment Integrity, the Manager, Payment Integrity Enablement provides strategic and operational leadership over enterprise-wide payment accuracy education, provider billing guidance, and compliance‑aligned intervention programs. This position collaborates cross‑functionally with Claims, Provider Relations, Compliance, and SIU/FWA to ensure audit readiness, operational consistency, and alignment with contractual and regulatory requirements. The Manager drives proactive identification of risk areas, supports provider coding accuracy to further billing accuracy, and ensures that Payment Integrity Enablement initiatives deliver measurable financial and operational outcomes.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

Competitive salary
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Life, short-term, and long‑term disability options
Career advancement opportunities and professional development
Wellness programs that promote a healthy work‑life balance
Flexible Spending Account – Health Care/Childcare
CalPERS retirement
457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance

Education & Requirements

A minimum of seven (7) years of experience in a combination of healthcare payment integrity, revenue cycle, and/or fraud, waste, and abuse (FWA) prevention required
Prior leadership experience mentoring, coaching, or training team members required
Experience with all lines of business offered by IEHP (i.e. Medi‑Cal, Medicare, and Commercial managed care) preferred
Bachelor’s degree in healthcare administration, Business, or a related field from an accredited institution required.
Master’s degree in healthcare administration, Business, or a related field from an accredited institution preferred
Certification such as Certified Professional Coder (CPC), Certified Healthcare Auditor (CHA), Certified Coding Specialist (CCS), PMP, or related certification is required

Key Qualifications

Must have a valid California Driver’s license
Deep understanding of managed care operations, ICD‑10/CPT coding, and state/federal billing regulations
Strong ability and knowledge to analyze market trends, anticipate future changes, and develop long‑term strategies that align with the company's goals
Strong knowledge of SIU/FWA methodologies and risk indicators
Communication skills with excellent presentation and instructional abilities to translate complex billing policies for diverse audiences
Strong analytical, problem‑solving, and compliance monitoring skills
Strong project leadership and management skills
Proficiency of Microsoft Office suite, including Word, Excel, Teams and PowerPoint
Strong interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment
Excellent ability to set clear goals, develop strategic plans to achieve those goals, and inspire others to work towards a shared vision
Skills in mediating disputes and resolving conflicts in a fair and constructive manner
Skills in SQL, BI tools, or data mining platforms preferred
Proven ability to:

Prioritize, plan, and handle multiple tasks/demands simultaneously with a strong attention to detail
Work collaboratively and influence across multiple functional areas
Guide and support team members
Work effectively with cross functional partners to navigate workflows and resolve issues
Balance day‑to‑day oversight with longer term strategic improvements
Manage multiple priorities while maintaining attention to detail and compliance standards