Payment Integrity Program Manager (Managed Care) Remote

Molina Healthcare

401d • $66,456 - $129,590 • Remote

About The Position

The Payment Integrity Program Manager at Molina Healthcare is responsible for overseeing and managing the Health Plan Payment Integrity recovery processes. This fully remote role involves executing and monitoring Scorable Action Items (SAIs) to ensure quality and performance in Payment Integrity business products and processes. The manager will collaborate with the Payment Integrity team to meet operational goals and support various initiatives related to overpayment recovery, post-payment data mining, and claim payment analysis.

Requirements

• Bachelor's Degree or equivalent combination of education and experience.
• 3-5 years of Program and/or Project management experience.
• Operational Process Improvement experience.
• Healthcare experience.
• Experience with Microsoft Project and Visio.
• Excellent presentation and communication skills.
• Experience partnering with different levels of leadership across the organization.

Nice To Haves

• Graduate Degree or equivalent combination of education and experience.
• 5-7 years of Program and/or Project management experience.
• Managed Care experience.
• Experience working in a cross-functional highly matrixed organization.
• PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification and/or comparable coursework.

Responsibilities

• Oversee the production and resolution of Health Plan Payment Integrity recovery concepts.
• Execute and monitor Health Plan Scorable Action Items (SAIs) to ensure performance and quality levels.
• Establish procedures and techniques to achieve operational goals.
• Manage inventory and collaborate with the Payment Integrity team to meet Health Plan SAI targets.
• Support implementation and execution of department initiatives in areas such as overpayment recovery and claim payment analysis.
• Prioritize recovery processing, offset reconciliation, and refund posting.
• Support provider dispute resolution and claim referrals.
• Review Draft Coding/Payment Policies against regulatory guidance and provide feedback.
• Partner with Government Contracts team to confirm state-specific requirements impacting SAIs.

Benefits

• Competitive benefits and compensation package.

What This Job Offers

• Job Type: Full-time
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree