Payment Integrity Lead — Recovery & Compliance

Molina Healthcare; Northern (KY); Hybrid; USD 66,000 - 143,000; Full time

Job summary

Molina Healthcare in Kentucky is seeking a leader to manage the payment integrity team, overseeing recovery operations, performance metrics, and procedures that achieve optimal readiness and production targets.

The role emphasizes staff development, vendor collaboration, data analysis, compliance with CMS/state regulations, and driving process improvements through automation and data accuracy.

Qualifications

• 7+ years of experience supporting health care operations, including 4 years payment integrity/claims experience.
• 1+ year of management/leadership experience.

Responsibilities

• 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 to resolve system or process issues impacting payment accuracy.
• Reviews and refines workflows and standard operating procedures to improve efficiency, accuracy, and audit readiness.

Skills

Leadership

Communication

Time management

Microsoft Office

Job description

Molina Healthcare in Kentucky is seeking a leader to manage the payment integrity team, overseeing recovery operations, performance metrics, and procedures that achieve optimal readiness and production targets.

The role emphasizes staff development, vendor collaboration, data analysis, compliance with CMS/state regulations, and driving process improvements through automation and data accuracy.