Manager, Payment Integrity Enablement

What you can expect!

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!

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.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

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

Education & 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 required

Prior leadership experience mentoring, coaching, or training team members required

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 required.

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 is required

Key Qualifications

Must have a valid California Driver’s license

Deep understanding of managed care operations, ICD-10/CPT coding, and state/federal billing regulations

Strong ability and knowledge to analyze market trends, anticipate future changes, and develop long-term strategies that align with the company's goals

Strong knowledge of SIU/FWA methodologies and risk indicators

Communication skills with excellent 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 of 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 to achieve those goals, and inspire others to work towards 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 a 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

Some travel involved to conduct training with providers onsite, as needed

Start your journey towards a thriving future with IEHP and apply TODAY !