Manager, Payment Integrity Enablement

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience.

About the role

Reporting to the Director of Payment Integrity, the Manager, Payment Integrity Enablement provides strategic and operational leadership over enterprise-wide payment accuracy education, provider billing guidance, and compliance-aligned intervention programs. This role oversees the end-to-end design, development, governance, and execution of training and enablement strategies that reduce payment errors, enhance coding accuracy, and promote compliance with state and federal guidelines.

The Manager leads a team responsible for curriculum development, operational workflow standardization, and performance improvement across Payment Integrity functions. This position collaborates cross-functionally with Claims, Provider Relations, Compliance, and SIU/FWA to ensure audit readiness, operational consistency, and alignment with contractual and regulatory requirements. The Manager drives proactive identification of risk areas, supports provider coding accuracy to further billing accuracy, and ensures that Payment Integrity Enablement initiatives deliver measurable financial and operational outcomes.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Responsibilities

• Provide strategic and operational leadership for enterprise-wide payment accuracy education, provider billing guidance, and compliance-aligned intervention programs
• Oversee end-to-end design, development, governance, and execution of training and enablement strategies
• Lead a team responsible for curriculum development, operational workflow standardization, and performance improvement
• Collaborate cross-functionally with Claims, Provider Relations, Compliance, and SIU/FWA to ensure audit readiness and operational consistency
• Drive proactive identification of risk areas and support provider coding accuracy
• Ensure Payment Integrity Enablement initiatives deliver measurable financial and operational outcomes
• Conduct onsite provider training as needed

Requirements

• A minimum of seven (7) years of experience in a combination of healthcare payment integrity, revenue cycle, and/or fraud, waste, and abuse (FWA) prevention
• Prior leadership experience mentoring, coaching, or training team members
• Experience with all lines of business offered by IEHP (i.e. Medi-Cal, Medicare, and Commercial managed care) preferred
• Bachelor’s degree in healthcare administration, Business, or a related field from an accredited institution
• Master’s degree in healthcare administration, Business, or a related field from an accredited institution preferred
• Certification such as Certified Professional Coder (CPC), Certified Healthcare Auditor (CHA), Certified Coding Specialist (CCS), PMP, or related certification
• Valid California Driver’s license

Qualifications

• Deep understanding of managed care operations, ICD-10/CPT coding, and state/federal billing regulations
• Strong ability to analyze market trends, anticipate future changes, and develop long-term strategies
• Strong knowledge of SIU/FWA methodologies and risk indicators
• Excellent communication, presentation, and instructional abilities to translate complex billing policies for diverse audiences
• Strong analytical, problem-solving, and compliance monitoring skills
• Strong project leadership and management skills
• Proficiency in Microsoft Office suite, including Word, Excel, Teams, and PowerPoint
• Strong interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment
• Excellent ability to set clear goals, develop strategic plans, and inspire others toward a shared vision
• Skills in mediating disputes and resolving conflicts in a fair and constructive manner
• Skills in SQL, BI tools, or data mining platforms preferred
• Proven ability to:
  • Prioritize, plan, and handle multiple tasks/demands simultaneously with strong attention to detail
  • Work collaboratively and influence across multiple functional areas
  • Guide and support team members
  • Work effectively with cross-functional partners to navigate workflows and resolve issues
  • Balance day-to-day oversight with longer-term strategic improvements
  • Manage multiple priorities while maintaining attention to detail and compliance standards

Benefits

• Competitive salary
• State-of-the-art fitness center on-site
• Medical Insurance with Dental and Vision
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development
• Wellness programs that promote a healthy work-life balance
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

Pay

$104,041.60 USD Annually - $137,841.60 USD Annually