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Manager, Payment Integrity - REMOTE
Molina Healthcare Austin, Texas; Owensboro, Kentucky; Savannah, Georgia; Lincoln, Nebraska; Sioux City, Iowa; Idaho; Green Bay, Wisconsin; Des Moines, Iowa; Macon, Georgia; Milwaukee, Wisconsin; Vancouver, Washington; Nampa, Idaho; Tacoma, Washington; Ann Arbor, Michigan; Cincinnati, Ohio; Grand Rapids, Michigan; Rio Rancho, New Mexico; Columbus, Ohio; Salt Lake City, Utah; Lexington-Fayette, Kentucky; Provo, Utah; Scottsdale, Arizona; Texas; Iowa; Wisconsin; New York; Layton, Utah; Phoenix, Arizona; Cedar Rapids, Iowa; Buffalo, New York; Everett, Washington; Covington, Kentucky; Jacksonville, Florida; Syracuse, New York; Las Cruces, New Mexico; Augusta, Georgia; Miami, Florida; Grand Island, Nebraska; Idaho Falls, Idaho; Meridian, Idaho; Albany, New York; Kenosha, Wisconsin; Bellevue, Washington; Bellevue, Nebraska; Caldwell, Idaho; St. Petersburg, Florida; Ohio; Racine, Wisconsin; Bowling Green, Kentucky; Louisville, Kentucky; Madison, Wisconsin; Columbus, Georgia; Tucson, Arizona; Rochester, New York; Detroit, Michigan; Tampa, Florida; Boise, Idaho; West Valley City, Utah; Utah; Omaha, Nebraska; Georgia; Nebraska; Iowa City, Iowa; Orem, Utah; Fort Worth, Texas; Orlando, Florida; Sterling Heights, Michigan; Mesa, Arizona; Houston, Texas; Spokane, Washington; Kentucky; Davenport, Iowa; Florida; Dayton, Ohio; Akron, Ohio; Cleveland, Ohio; Santa Fe, New Mexico; Albuquerque, New Mexico; Roswell, New Mexico; Dallas, Texas; Chandler, Arizona; New Mexico; Michigan; San Antonio, Texas; Kearney, Nebraska; Atlanta, Georgia; Yonkers, New York; Warren, Michigan; Washington Job ID 2033532JOB DESCRIPTION
Job Summary
Responsible for planning, developing, and directing the implementation of techniques to ensure the maintenance of performance and quality levels in the Business' products and processes. Reviews operation process designs and establishes procedures and techniques for operational standards. Confers with customers to define and resolve
KNOWLEDGE/SKILLS/ABILITIES
- With direction from Director or AVP of Payment Integrity, leads the implementation of department/companywide initiatives that would include one or all of the following areas: Overpayment Recovery, Pre- and Post-pay COB, Subrogation, Premium Enhancement (such as ESRD and Medicare Secondary Payer) and Pre-pay Editing for correct coding and medical payment polices. Many of these activities include oversight of vendors that are supplemental to internal processes and activities.
- Manage team members and responsible for executing projects and activities involving inventory management, information reporting, database configuration, procedures, and workflow to ensure quality controls and timely turnaround.
- Responsible for facilitating meetings with health plans and vendors for ideation and approval of payment integrity initiatives.
- Analyze and document business rules requirements to corporate configuration for COB and claims edits logic in the QNXT systems as well as maintenance to the internal Payment Integrity Tracking databases.
- Assist and execute tasks and projects in ensuring CMS and state regulatory requirements are met, for Pre-pay Edits, Overpayment Recovery, COB and Subrogation, which improves encounter submissions, reduces G&A costs, and continues to drive positive operation and financial outcomes for all solutions.
- Evaluates analytical findings to ensure accurate interpretation of meaningful data mining results.
- Designs programs that prioritize identified and resolve payment issues.
JOB QUALIFICATIONS
Required Education
Bachelor’s degree or equivalent combination of education and experience
Required Experience
5-7 years
Preferred Experience
10+ years
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $77,969 - $155,508 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type Full Time Posting Date 09/12/2025Job Alerts
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