Manager, Payment Integrity

Description JOB DESCRIPTION Job Summary - Leads and manages team responsible for payment integrity activities including recovery operations. - Responsible for performance, quality levels and establishing procedures and techniques that achieve optimal payment integrity operational standards and production targets. Essential Job Duties - 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. Required Qualifications - At least 7 years of experience supporting health care operations, including 4 years payment integrity/claims experience, or equivalent combination of relevant education and 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 and applicable software program(s) proficiency. Preferred Qualifications - Managed care payor experience, preferably with Medicare/Medicaid government-sponsored programs. - Understanding of ICD-9/10CM, MS-, AP- and APR-DRG reimbursement. - Electronic medical record (EMR) and medical record repository experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V