Manager, Payment Integrity Enablement

Jobtailor; Rancho Cucamonga (CA); On-site; USD 120,000 - 180,000; Full time

Job summary

Jobtailor seeks a senior leader to oversee the design, implementation, and continuous improvement of Payment Integrity Enablement programs, training modules, and job aids focused on coding accuracy, claim edits, and medical cost containment.

You will direct training delivery for healthcare providers, billing staff, and internal claims analysts to prevent common billing errors and support improved coding accuracy.

Qualifications

• Experience in healthcare payment integrity, revenue cycle, or FWA prevention.
• Leadership experience mentoring, coaching, or training team members.
• Deep understanding of managed care operations and billing regulations.
• Ability to analyze market trends and develop long-term strategies.

Responsibilities

• Manage and oversee design, implementation, and improvement of Payment Integrity Enablement programs and training materials.
• Ensure programs are executed consistently and aligned with regulatory, contractual, and financial expectations.
• Direct training delivery to providers, billing staff, and internal analysts to improve coding accuracy.
• Establish delivery standards, measure effectiveness, and drive adoption of best practices.
• Monitor federal/state regulations (CMS, DHCS) to guide billing and reimbursement training.
• Develop and track KPIs related to training impact and error reduction.
• Collaborate with cross-functional partners on remediation and continuous improvement.
• Lead change management and operational readiness for new billing standards.

Skills

Coding Accuracy

Regulatory Compliance

KPI Development

Risk Assessment

Project Management

Data Analysis

Change Management

Quality Review

Billing Regulations

FWA Prevention

Communication Skills

Interpersonal Skills

Team Leadership

Education

Bachelor's degree in Healthcare Administration

Master's degree in Healthcare Administration or related field

Certified Professional Coder (CPC) / CHA / CCS / PMP

Tools

Microsoft Office Suite

SQL

BI Tools

Data Mining Platforms

Job description

• Manage and oversee the design, implementation, and continuous improvement of Payment Integrity Enablement programs and training materials, recorded modules, and job aids focused on coding accuracy, claim edits, and medical cost containment
• Ensure Payment Integrity Enablement programs are executed consistently, documented clearly, and aligned with regulatory, contractual, and financial expectations
• Direct training delivery for healthcare providers, billing staff, and internal claims analysts to prevent common billing errors and support improved coding accuracy
• Establish delivery standards, evaluate training effectiveness, and drive adoption of best practices
• Establish frameworks to identify and assess enablement risks such as coding gaps, provider misunderstanding, and emerging regulatory vulnerabilities
• Escalate significant findings to Payment Integrity leadership, SIU/FWA, or Compliance and collaborate with cross-functional partners on remediation and continuous improvement
• Monitor and interpret federal/state regulations, including CMS and DHCS, to guide training and educational materials for accurate billing, coding, and reimbursement practices
• Develop and track KPIs related to training effectiveness, coding accuracy improvements, reduction in spend, and error rate trends
• Report program impact and adoption metrics to Payment Integrity leadership
• Assess root causes of payment errors and incorporate findings into training programs to resolve recurring trends
• Collaborate with SIU/FWA leadership and analytics teams to identify high-risk provider patterns and adjust enablement programs
• Partner with Claims, Provider Relations, and external vendors on payment integrity guidelines
• Develop communication plans for billing changes, regulatory shifts, and new payment integrity expectations
• Establish standardized workflows, documentation, quality review expectations, and version control for training materials, job aids, policies, and curricula
• Lead change management and operational readiness initiatives for new billing standards, regulatory updates, and Payment Integrity policies
• Oversee daily operations of the Payment Integrity Enablement unit
• Provide leadership, coaching, and guidance to the team; support employee development and reinforce operational standards
• Perform other duties required to support Health Plan operations and department business needs

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
• 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
• Proven ability to work collaboratively and influence across multiple functional areas
• Proven ability to guide and support team members
• Proven ability to work effectively with cross functional partners to navigate workflows and resolve issues
• Proven ability to balance day-to-day oversight with longer term strategic improvements
• Proven ability to manage multiple priorities while maintaining attention to detail and compliance standards
• Some travel involved to conduct training with providers onsite, as needed

Core Competencies

Demonstrates expertise in Payment Integrity Enablement, focusing on coding accuracy, compliance with federal and state regulations, and effective training delivery for healthcare providers. Proven ability to lead teams, develop strategic plans, and implement continuous improvement initiatives in healthcare payment integrity.

Highest-signal resume keywords

• Healthcare Payment Integrity
• ICD-10/CPT Coding
• Certified Professional Coder (CPC)
• Training Delivery and Development
• Leadership and Team Development

ATS Optimization Keywords

Hard Skills

• Coding Accuracy
• Regulatory Compliance
• KPI Development and Tracking
• Risk Assessment
• Project Management
• Data Analysis
• Change Management
• Quality Review
• Billing Regulations
• Fraud, Waste, and Abuse (FWA) Prevention

Soft Skills

• Communication Skills
• Analytical Problem-Solving
• Interpersonal Skills
• Conflict Resolution
• Teamwork

Certifications & Qualifications

• Certified Professional Coder (CPC)
• Certified Healthcare Auditor (CHA)
• Certified Coding Specialist (CCS)
• Project Management Professional (PMP)

Industry Keywords

• Managed Care Operations
• Revenue Cycle Management
• Healthcare Administration
• Billing Standards
• Provider Relations

Tools & Technologies

• Microsoft Office Suite
• SQL
• BI Tools
• Data Mining Platforms