Senior Payment Integrity Lead — Recovery & Compliance

Molina Healthcare, Inc.; Oregon; Hybrid; USD 90,000 - 130,000; Full time

Job summary

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.

Responsibilities

• 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.

Skills

Leadership experience

Communication skills

Time management

MS Office proficiency

Tools

MS Office

Job description

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.