Molina Healthcare

Director, Payment Integrity - REMOTE EST OR CST

Molina Healthcare • $125K — $150K *
US-AnywhereRemote in United States
Healthcare
8 - 10 years of experience
Today
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Job Overview by Ladders

Qualifications

  • 8+ years in healthcare operations (5+ in payment integrity)
  • 3+ years in a leadership role
  • Experience with managed care payor systems (Medicare/Medicaid focus)
  • Ability to foster effective relationships across all levels
  • Strong organizational skills for multitasking
  • Excellent communication skills (verbal and written)
  • Proficient in Microsoft Office and relevant software

Responsibilities

  • Develop and implement the strategic roadmap for payment integrity concepts
  • Oversee the complete lifecycle of payment integrity initiatives
  • Drive continuous improvement for automation and performance enhancement
  • Lead and mentor a team of Business Analysts
  • Establish performance and development plans for team members
  • Ensure governance and accuracy of key documentation
  • Manage change and maintenance activities for concepts
  • Translate healthcare policies and opportunities into actionable solutions
  • Create best practices for documentation and implementation
  • Serve as the primary liaison for health plans
  • Support initiatives to enhance payment accuracy and recovery
  • Monitor industry trends to guide strategic decisions

Benefits

  • Competitive benefits package
  • Opportunities for professional development
  • Supportive work environment
  • Focus on continuous improvement
  • Engagement with executive leadership to influence key decisions
Full Job Description
Job Description

JOB DESCRIPTION

Job Summary

Responsible for leading the strategic development, governance, implementation, maintenance, and optimization of the organization's post-pay payment integrity concept portfolio. This role leads a team of Business Analysts responsible for maintaining concept white papers, business requirements, operational specifications, and enhancement requests supporting Molina's portfolio of post pay concepts.

The Director serves as a key liaison between Health Plans, Data Science, and Executive Leadership teams to ensure payment integrity concepts are effectively developed, implemented, maintained, and optimized to achieve financial and operational objectives. This position oversees a high-volume, fast-paced environment supporting concept lifecycle management, stakeholder engagement, and continuous improvement initiatives.

Essential Job Duties
  • Develop and execute the strategic roadmap for the post-pay payment integrity concept portfolio, ensuring alignment with organizational financial, operational, and regulatory objectives.
  • Oversee the end-to-end lifecycle of payment integrity concepts, including intake, prioritization, requirements development, implementation, testing, deployment, maintenance, enhancement, and retirement.
  • Champion and drive continuous improvement initiatives that enhance scalability, automation, productivity, and concept performance.
  • Lead, mentor, and develop a team of Business Analysts responsible for concept white papers, business requirements, enhancement requests, and concept maintenance activities.
  • Establish performance expectations, development plans, and succession strategies that support organizational growth and talent development.
  • Ensure the accuracy, consistency, and governance of concept white papers, business requirements, operational specifications, and supporting documentation.
  • Provide oversight of concept change management, maintenance activities, and enhancement requests to ensure timely and accurate delivery.
  • Translate healthcare reimbursement policies, coding guidelines, and business opportunities into actionable business requirements and analytical solutions.
  • Develop standards and best practices for concept documentation, requirements management, testing, and implementation.
  • Serve as the primary business leader and escalation point for health plans regarding concept methodologies, performance, implementation questions, maintenance activities, and enhancement requests.
  • Support organizational initiatives that improve payment accuracy, reduce administrative burden, and maximize recovery opportunities.
  • Ensure compliance with regulatory requirements, reimbursement policies, coding standards, and organizational governance practices.
  • Monitor industry trends, regulatory changes, and emerging payment integrity opportunities to inform strategic direction and concept development priorities.

Required Qualifications
  • At least 8 years of experience supporting health care operations, including 5 years payment integrity/claims experience, or equivalent combination of relevant education and experience.
  • At least 3 years management/leadership experience.
  • Managed care payor experience, preferably in Medicare/Medicaid government-sponsored programs.
  • 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.
  • Excellent verbal and written communication skills.
  • Microsoft Office suite and applicable software program(s) proficiency.

Preferred Qualifications
  • Knowledge of CPT, HCPCS, ICD-10-CM, ICD-10-PCS, NCCI, DRG, and reimbursement methodologies.
  • Strong understanding of healthcare claims processing, reimbursement methodologies, coding systems, and payment integrity principles.
  • Experience developing and managing business requirements, process documentation, or operational specifications.
  • Experience managing payment integrity concept governance, portfolio management, and health plan engagement functions.
  • 5 years of leadership experience managing teams responsible for payment integrity analytics, claim configuration, claims auditing, or related functions.

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.

About Molina Healthcare

Molina Healthcare focuses exclusively on government-sponsored health care programs for families and individuals who qualify for government-sponsored health care. It contracts with state governments and serves as a health plan, providing a wide range of quality health care services to families and individuals.

Molina Healthcare Careers

Join the dedicated team at Molina Healthcare, a leader in providing quality healthcare services to families and individuals who qualify for government-sponsored programs, including Medicaid and Medicare. As one of the most respected companies in the health services industry, Molina Healthcare offers unparalleled job opportunities aimed at empowering your career growth and professional development.

Work You’ll Do

At Molina Healthcare, you will engage in meaningful work that directly impacts lives across the country. Our team is committed to innovation in healthcare, ensuring that all members receive the best care possible. By joining us, you will collaborate with skilled professionals dedicated to our mission of providing accessible, high-quality healthcare.

Career Opportunities and Growth

Whether you are looking for your first job, seeking a leadership role, or aiming to specialize in healthcare professions, Molina Healthcare offers a range of career paths. Our job opportunities span across various functions, including clinical services, customer support, IT, project management, and more. We believe in fostering the growth of our employees through professional development, leadership training, and diversity initiatives.

Internship Programs

Kickstart your career with a Molina Healthcare internship. Our internships provide invaluable workplace experience, offering a glimpse into the healthcare industry through hands-on projects and mentorship. Interns at Molina Healthcare gain critical skills that prepare them for future employment, making them competitive candidates in the job market.

Culture and Benefits

Molina Healthcare is not just a company; it’s a community. We prioritize a culture of inclusivity and respect, where all team members are encouraged to bring their whole selves to work. Our employees enjoy comprehensive benefits, including health insurance, retirement plans, and wellness programs, all designed to support both their professional and personal lives.

Join Our Team

Explore the various positions available at Molina Healthcare and find where your skills and interests align with our needs. We are continuously hiring talented individuals who are passionate about making a difference in healthcare. Prepare your resume, sharpen your interview skills, and become part of a team that values hard work and creativity.

Stay Connected

Keep up to date with the latest at Molina Healthcare: - **Career Growth and Networking:** Advance your career through our professional development and networking opportunities. Learn from leaders and peers alike to build connections that propel your career forward. - **Innovation and Leadership:** Drive change and lead with confidence by participating in our leadership and innovation training programs.

Apply Now

Ready to take the next step in your healthcare career? Search open positions that match your skills and interests on the Molina Healthcare Jobs portal. We look for driven, curious, and compassionate team players ready to make an impact.

Stay Informed

Subscribe to Molina Healthcare job alerts and receive updates on new openings and company news directly to your inbox. Tailor your subscription to match your career preferences and stay ahead in the dynamic field of healthcare. Join Molina Healthcare, where your career is nurtured, your contributions are valued, and your growth is guaranteed.
Learn more about Molina Healthcare
Size
14,000 employees
Market Cap
$19.5 billion
Industry
Healthcare
Net Income
$673 million
Founded
1980
5 Year Trend
+9.3%
Revenue
$19.4 billion
NASDAQ
MOH
* Ladders Estimates

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