Manager, Payment Integrity Enablement

Inland Empire Health Plans; Rancho Cucamonga (CA); On-site; USD 120,000 - 180,000; Full time

Benefits offered by this job

Competitive salary

State of the art fitness center on‑sit

Medical Insurance with Dental and VIs}

Job summary

Inland Empire Health Plans (IEHP) invites you to join our Payment Integrity Enablement team as Manager, leading education, provider guidance, and compliance initiatives to reduce errors and promote billing accuracy.

Reporting to the Director of Payment Integrity, you will oversee curriculum design, governance, and training delivery, collaborate with Claims, Compliance, and SIU/FWA, and drive measurable financial and operational improvements aligned with IEHP's quality goals.

Qualifications

• Seven years of experience in healthcare payment integrity, revenue cycle, and/or FWA prevention.
• Leadership experience mentoring, coaching, or training team members.
• Experience with IEHP lines of business (Medi-Cal, Medicare, Commercial) preferred.
• Bachelor’s degree in healthcare administration or related field required; master’s preferred.
• Certification such as CPC, CHA, CCS, PMP or related required.

Responsibilities

• Provide strategic and operational leadership over education and training for payment integrity.
• Oversee end-to-end design, governance, and execution of training programs.
• Collaborate cross-functionally with Claims, Provider Relations, Compliance, and SIU/FWA.
• Lead curriculum development, standardize operations, and drive performance improvements.
• Identify risk areas and promote coding accuracy to improve billing integrity.

Skills

Leadership

Training & mentoring

Communication & presentation

Data analysis

Project management

Regulatory compliance

Cross-functional collaboration

SQL

BI tools

Data mining platforms

Education

Bachelor’s degree in healthcare administration

Master’s degree in healthcare administration

Certification: CPC/CHA/CCS/PMP

Tools

Microsoft Office

SQL

BI tools

Data mining platforms

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!

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 role oversees the end‑to‑end design, development, governance, and execution of training, and enablement strategies that reduce payment errors, enhance coding accuracy, and promote compliance with state and federal guidelines.

The Manager leads a team responsible for curriculum development, operational workflow standardization, and performance improvement across Payment Integrity functions. 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
• Some travel involved to conduct training with providers onsite, as needed