Payment Integrity Manager - Lead Recovery & QA

Molina Healthcare, Inc.; United States; Remote; USD 120,000 - 180,000; Full time

Job summary

Molina Healthcare, Inc. is seeking a senior leader to direct payment integrity operations, driving performance, quality, and cost-avoidance initiatives across the team. This role partners with Shared Services to resolve complex issues and optimize workflows.

The position emphasizes staff development, rigorous metrics, and regulatory compliance with CMS/state requirements, while advancing process automation and data integrity initiatives within healthcare operations.

Qualifications

• At least 7 years of experience supporting health care operations, including 4 years payment integrity/claims 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 proficiency.

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 (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.

Job description

Molina Healthcare, Inc. is seeking a senior leader to direct payment integrity operations, driving performance, quality, and cost-avoidance initiatives across the team. This role partners with Shared Services to resolve complex issues and optimize workflows.

The position emphasizes staff development, rigorous metrics, and regulatory compliance with CMS/state requirements, while advancing process automation and data integrity initiatives within healthcare operations.