Manager, Payment Integrity Enablement

Inland-Empire-Health-Plan-; Rancho Cucamonga (CA); Hybride; USD 104 000 - 138 000; Plein temps

Avantages offerts par ce poste

Competitive salary

State of the art fitness center on‑sit

Medical Insurance with Dental and Vis

Life, short-term, and long-term-dis

Career advancement opportunities

Wellness programs

Flexible Spending Account – HealthCare

CalPERS retirement

457(b) match

Paid life insurance

Pet care insurance

Résumé du poste

Inland Empire Health Plan (IEHP) in Rancho Cucamonga, CA seeks a Manager to lead enterprise-wide Payment Integrity Enablement training focused on coding accuracy, claim edits, and compliance with state and federal guidelines.

You will oversee curriculum design, governance, and delivery, collaborating with Claims, Provider Relations, Compliance, and SIU/FWA to drive measurable improvements and audit readiness.

Qualifications

• Minimum seven years in healthcare payment integrity, revenue cycle, or FWA prevention.
• Leadership experience mentoring or coaching team members.
• Bachelor’s degree in healthcare administration or related field; Master’s preferred.
• Certification such as CPC/CHA/CCS/PMP required.

Responsabilités

• Design, implement, and oversee Payment Integrity Enablement programs and training materials.
• Deliver training to providers, billing staff, and internal claims analysts.
• Identify enablement risks and coordinate remediation with cross-functional partners.

Connaissances

Leadership

Training experience

Healthcare operations

Coding accuracy

Regulatory compliance

Cross-functional collaboration

Formation

Bachelor’s degree in healthcare administration

Master’s degree in healthcare administration

CPC/CHA/CCS/PMP certification

Outils

SQL

BI tools

Microsoft Excel

Description du poste

Overview

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 anauthentic 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.

Additional Benefits

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

Key Responsibilities

• Program and Curriculum Design: 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.
• Provider & Internal Staff Education: 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.
• Policy, Compliance, & Risk Tracking: Establish frameworks to identify and assess enablement risks such as coding gaps, provider misunderstanding, and emerging regulatory vulnerabilities. Ensure that significant findings are escalated to Payment Integrity leadership, SIU/FWA, or Compliance and collaborate with cross functional partners to drive timely remediation and continuous improvement. Oversee the monitoring and interpretation of federal/state regulations (CMS, DHCS, and/or similar regulations) and IEHP compliance standards to direct and guide the development, continuous maintenance, and delivery of training and educational materials that ensure accurate billing, coding, and reimbursement practices accordingly.
• Performance Analysis: Develop and track Key Performance Indicators (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. Partner with internal leadership to assess root causes of payment errors and ensure the adoption of findings into training programs to resolve recurring trends.
• Vendor & Cross-Functional Collaboration: Collaborate with SIU/FWA leadership and analytics teams to identify high‑risk provider patterns and adjust enablement programs accordingly. Partner with Claims, Provider Relations, and external vendors to ensure alignment on payment integrity guidelines.
• Stakeholder Communication & Engagement Strategy: Serve as the operational driver for Payment Integrity Enablement interventions, ensuring programs scale effectively, are audit-ready, and deliver measurable reductions in inaccurate or wasteful spend. Develop communication plans to ensure providers and internal teams receive timely updates about billing changes, regulatory shifts, and new payment integrity expectations.
• Content Governance & Version Control: Establish standardized workflows, documentation, and quality review expectations across all Payment Integrity teams. Maintain a central repository of all training materials, job aids, policies, and curriculum updates. Oversee version control and approvals, ensuring materials remain accurate, compliant, and current.
• Operational Readiness: Lead change management initiatives, ensuring adoption of new billing standards, regulatory updates, and Payment Integrity policies across the organization and provider network. Oversee operational readiness assessments for new enablement programs, ensuring that Claims, Provider Relations, IT, and vendors are prepared before rollout.
• Operational Management: Oversee the daily operations of the Payment Integrity Enablement unit. Provide leadership, coaching, and guidance to the team to ensure high performance, accountability, and engagement. Support employee development, reinforce operational standards, and create a collaborative environment that aligns with departmental and organizational goals.
• Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Qualifications

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

Work Model Location

This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.)

Some travel involved to conduct training with providers onsite, as needed

Pay Range

USD $104,041.60 - USD $137,841.60 /Yr.