Remote Director, Payment Integrity & Recovery Strategy

Molina Healthcare, Inc.; Washington; Remote; USD 140,000 - 210,000; Full time

Job summary

Molina Healthcare, Inc. seeks a senior leader to head payment integrity initiatives, overseeing multi-market operations and driving recovery efficiency. You will shape strategic roadmaps, govern program areas, and partner with executive teams on planning, rate setting, and compliance.

The role emphasizes governance, analytics, and automation, with a focus on building organizational capability and leadership succession within the Payment Integrity function.

Qualifications

• At least 8 years of experience supporting health care operations, including 5 years payment integrity/claims experience.
• 3+ years in management/leadership roles.
• Experience with managed care payor programs (Medicare/Medicaid) preferred.
• Ability to build positive working relationships with coworkers, members, providers and customers.
• Strong organizational and time-management skills with ability to handle multiple projects.
• Excellent verbal and written communication skills.
• Proficient in Microsoft Office and related software.

Responsibilities

• Develops and executes the strategic roadmap for payment integrity functions across markets.
• Oversight of program areas like COB, subrogation, data mining, pre-pay edits, and PI disputes.
• Leads enterprise projects driving financial improvement and operating transformation.
• Partners with executives to align payment integrity with planning, rate setting, and compliance.
• Sets departmental goals, KPIs, and reporting to measure outcomes.
• Provides SME on claims processing, configuration logic, audit readiness, and vendor governance.
• Represents Payment Integrity in governance meetings and regulatory discussions.
• Oversees vendor selection, contracting, and ROI management for recovery efficiency.
• Champions automation and data-driven decision making.
• Mentors leaders and develops succession pipelines.

Skills

Strategic planning

Leadership

Healthcare payer experience

Stakeholder relations

Time management

Communication

MS Office

Job description

Molina Healthcare, Inc. seeks a senior leader to head payment integrity initiatives, overseeing multi-market operations and driving recovery efficiency. You will shape strategic roadmaps, govern program areas, and partner with executive teams on planning, rate setting, and compliance.

The role emphasizes governance, analytics, and automation, with a focus on building organizational capability and leadership succession within the Payment Integrity function.