Manager, Payment Integrity - REMOTE

Molina Healthcare; Oregon; Hybride; USD 90 000 - 130 000; Plein temps

Résumé du poste

Molina Healthcare, Inc. is seeking a senior leader to manage the payment integrity team, ensuring accuracy, timely processing, and adherence to policies. The role focuses on performance, quality, and developing standardized procedures to achieve optimal targets.

The position requires extensive healthcare operations and payment integrity experience, with strong leadership, collaboration with Shared Services, and capability to drive continuous improvement across the function.

Qualifications

• 7+ years in health care operations with 4+ years in payment integrity/claims.
• Minimum 1 year of management/leadership experience.
• Ability to establish positive working relationships with coworkers, members, providers and customers.
• Strong organizational and time-management skills; ability to manage multiple projects.
• Strong verbal and written communication skills.

Responsabilités

• Leads day-to-day operations for payment integrity programs, ensuring accuracy and timeliness.
• Hires, trains, and develops staff responsible for recovery performance and data integrity.
• Implements quality assurance programs and metrics to meet recovery targets.
• Collaborates with Shared Services to resolve system/process issues.
• Reviews workflows and SOPs to improve efficiency and audit readiness.
• Leads meetings with vendors and internal partners to discuss performance.
• Analyzes data to identify trends and propose improvements.
• Supports CMS and state regulatory compliance.
• Contributes to small to mid-scale process-improvement projects.
• Promotes accountability and continuous improvement within the team.

Connaissances

Leadership experience

Communication skills

Time management

MS Office proficiency

Outils

MS Office

Description du poste

JOB DESCRIPTION

Job Summary

Leads and manages team responsible for payment integrity activities including recovery operations. Responsible for performance, quality levels and establishing procedures and techniques that achieve optimal payment integrity operational standards and production targets.

Essential Job Duties

• 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 (Shared Services) 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.

Required Qualifications

• At least 7 years of experience supporting health care operations, including 4 years payment integrity/claims experience, or equivalent combination of relevant education and experience.
• At least 1 year management/leadership experience.
• Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and customers.
• Strong organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
• Strong verbal and written communication skills.
• Microsoft Office suite and applicable software program(s) proficiency.

Preferred Qualifications

• Managed care payor experience, preferably with Medicare/Medicaid government-sponsored programs.
• Understanding of ICD-9/10CM, MS-, AP- and APR-DRG reimbursement.
• Electronic medical record (EMR) and medical record repository experience.

Molina Healthcare offers a competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V