About the role
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
Pay Range: $65,791.66 - $142,548.59 / 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. Remote positions are U.S.-based only. Candidates must reside and be authorized to work in the United States.
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type Full Time
Posting Date 08/27/2026
Minimum requirements
- Minimum 7 years healthcare operations experience, including 4 years in payment integrity/claims
- At least 1 year management or leadership experience
- Proficiency in Microsoft Office and strong organizational, communication, and interpersonal skills
This listing was parsed by AI and may not be complete. Check the official posting on Molina Healthcare's site for the most accurate information.