Manager, Payment Integrity - REMOTE

Molina Healthcare•Long Beach, CA

8h•Remote

About The Position

Leads and manages a team responsible for payment integrity activities, including recovery operations. The Manager is responsible for team performance and quality levels and for establishing procedures and techniques that achieve optimal payment integrity operational standards and production targets. The role manages day-to-day operations for assigned payment integrity programs, oversees staff responsible for inventory management, reporting, data integrity, and recovery performance, and ensures accuracy, timeliness, and adherence to policies and procedures. It also monitors quality and performance metrics, collaborates with internal departments and vendors, improves workflows and standard operating procedures, analyzes operational data, supports regulatory compliance, and contributes to process improvement, automation, and data accuracy projects.

Requirements

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

Nice To Haves

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

Responsibilities

Lead and manage day-to-day operations for assigned payment integrity programs, ensuring accuracy, timeliness, and adherence to policies and procedures.
Hire, train, and develop staff responsible for inventory management, reporting, data integrity, and recovery performance.
Implement and monitor quality assurance programs and performance metrics to ensure recovery and cost avoidance targets are met.
Collaborate with internal departments (Shared Services) to resolve system or process issues that affect payment accuracy.
Review and refine workflows and standard operating procedures to improve efficiency, accuracy, and audit readiness.
Facilitate meetings with vendors and internal partners about production performance, operational barriers, and process optimization opportunities.
Analyze operational data to identify trends, evaluate recovery effectiveness, and propose actionable improvements.
Support compliance with CMS and state regulations.
Contribute to small- to mid-scale projects focused on process improvement, automation, and data accuracy.
Promote accountability, continuous improvement, and professional development within the team.