Full-Time
Payment Integrity Enablement Manager
Deadline 8/20/27
IEHP
Compensation Overview
$104k - $137.8k/yr
Rancho Cucamonga, CA, USA
Hybrid
On-site Tuesday through Thursday in Rancho Cucamonga; remote Monday and Friday. Travel to provider sites is required as needed.
Bachelor's, Master's
Category
 Training (2) |
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Required Skills
Microsoft Office
Data Science
SQL
Word/Pages/Docs
Version Control
Excel/Numbers/Sheets
PowerPoint/Keynote/Slides
Requirements
- A minimum of seven years of experience in a combination of healthcare payment integrity, revenue cycle, and/or fraud, waste, and abuse prevention is required.
- Prior leadership experience mentoring, coaching, or training team members is required.
- A bachelor's degree in healthcare administration, Business, or a related field from an accredited institution is required.
- A certification such as Certified Professional Coder, Certified Healthcare Auditor, Certified Coding Specialist, Project Management Professional, or a related certification is required.
- A valid California driver's license is required.
- Deep understanding of managed care operations, ICD-10 and CPT coding, and state and federal billing regulations is required.
- Strong ability and knowledge to analyze market trends, anticipate future changes, and develop long-term strategies aligned with organizational goals is required.
- Strong knowledge of Special Investigations Unit and fraud, waste, and abuse methodologies and risk indicators is required.
- Communication, presentation, and instructional abilities to translate complex billing policies for diverse audiences are required.
- Strong analytical, problem-solving, and compliance-monitoring skills are required.
- Strong project leadership and management skills are required.
- Proficiency with Microsoft Office, including Word, Excel, Teams, and PowerPoint, is required.
- Interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment are required.
- Ability to set clear goals, develop strategic plans, and inspire others toward a shared vision is required.
- Skills in mediating disputes and resolving conflicts fairly and constructively are required.
- Ability to prioritize, plan, and handle multiple tasks simultaneously while maintaining attention to detail is required.
- Ability to work collaboratively and influence across multiple functional areas is required.
- Ability to guide and support team members is required.
- Ability to work effectively with cross-functional partners to navigate workflows and resolve issues is required.
- Ability to balance day-to-day oversight with longer-term strategic improvements is required.
- Ability to manage multiple priorities while maintaining attention to detail and compliance standards is required.
Responsibilities
- Manage and oversee the design, implementation, and continuous improvement of Payment Integrity Enablement programs and training materials, recorded modules, and job aids focused on coding accuracy, claim edits, and medical cost containment.
- Direct training delivery for healthcare providers, billing staff, and internal claims analysts; establish delivery standards, evaluate training effectiveness, and drive adoption of best practices.
- Establish frameworks to identify and assess enablement risks, including coding gaps, provider misunderstanding, and emerging regulatory vulnerabilities.
- Escalate significant findings to Payment Integrity leadership, the Special Investigations Unit and fraud, waste, and abuse teams, or Compliance, and collaborate with cross-functional partners on timely remediation and continuous improvement.
- Monitor and interpret federal and state regulations, including Centers for Medicare & Medicaid Services and Department of Health Care Services regulations, and use them to guide training and educational materials for accurate billing, coding, and reimbursement.
- Develop and track key performance indicators related to training effectiveness, coding-accuracy improvements, spend reduction, and error-rate trends.
- Report program impact and adoption metrics to Payment Integrity leadership.
- Partner with internal leadership to assess root causes of payment errors and incorporate findings into training programs to resolve recurring trends.
- Collaborate with Special Investigations Unit and fraud, waste, and abuse leadership and analytics teams to identify high-risk provider patterns and adjust enablement programs.
- Partner with Claims, Provider Relations, and external vendors to align on payment integrity guidelines.
- Drive Payment Integrity Enablement interventions so programs scale effectively, remain audit-ready, and reduce inaccurate or wasteful spending.
- Develop communication plans to provide providers and internal teams with timely updates about billing changes, regulatory shifts, and new payment integrity expectations.
- Establish standardized workflows, documentation, and quality-review expectations across Payment Integrity teams.
- Maintain a central repository of training materials, job aids, policies, and curriculum updates.
- Oversee version control and approvals to keep materials accurate, compliant, and current.
- Lead change-management initiatives to ensure adoption of new billing standards, regulatory updates, and Payment Integrity policies across the organization and provider network.
- Oversee operational-readiness assessments for new enablement programs and ensure Claims, Provider Relations, Information Technology, and vendors are prepared before rollout.
- Oversee daily operations of the Payment Integrity Enablement unit.
- Provide leadership, coaching, and guidance to the team to ensure performance, accountability, and engagement.
- Support employee development, reinforce operational standards, and create a collaborative environment aligned with departmental and organizational goals.
- Perform other duties required to support Health Plan operations and department business needs.
Desired Qualifications
- Experience with all lines of business offered by IEHP, including Medi-Cal, Medicare, and Commercial managed care, is preferred.
- Skills in SQL, business-intelligence tools, or data-mining platforms are preferred.