Manager, Payment Integrity Enablement

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Requirements Summary

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

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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.

What We Offer

~1 min read

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

Responsibilities

~3 min read

→Program and Curriculum Design: 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. Ensure Payment Integrity Enablement programs are executed consistently, documented clearly, and aligned with regulatory, contractual, and financial expectations.

→Provider & Internal Staff Education: Direct training delivery for healthcare providers, billing staff, and internal claims analysts to prevent common billing errors and support improved coding accuracy. Establish delivery standards, evaluate training effectiveness, and drive adoption of best practices.

→Policy, Compliance, & Risk Tracking: Establish frameworks to identify and assess enablement risks such as coding gaps, provider misunderstanding, and emerging regulatory vulnerabilities. Ensure that significant findings are escalated to Payment Integrity leadership, SIU/FWA, or Compliance and collaborate with cross functional partners to drive timely remediation and continuous improvement. Oversee the monitoring and interpretation of federal/state regulations (CMS, DHCS, and/or similar regulations) and IEHP compliance standards to direct and guide the development, continuous maintenance, and delivery of training and educational materials that ensure accurate billing, coding, and reimbursement practices accordingly.

→Performance Analysis: Develop and track Key Performance Indicators (KPIs) related to training effectiveness, coding accuracy improvements, reduction in spend, 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 ensure the adoption of findings into training programs to resolve recurring trends.

→Vendor & Cross-Functional Collaboration: Collaborate with SIU/FWA leadership and analytics teams to identify high‑risk provider patterns and adjust enablement programs accordingly. Partner with Claims, Provider Relations, and external vendors to ensure alignment on payment integrity guidelines.

→Stakeholder Communication & Engagement Strategy: Serve as the operational driver for Payment Integrity Enablement interventions, ensuring programs scale effectively, are audit-ready, and deliver measurable reductions in inaccurate or wasteful spend. Develop communication plans to ensure providers and internal teams receive timely updates about billing changes, regulatory shifts, and new payment integrity expectations.

→Content Governance & Version Control: Establish standardized workflows, documentation, and quality review expectations across all Payment Integrity teams. Maintain a central repository of all training materials, job aids, policies, and curriculum updates. Oversee version control and approvals, ensuring materials remain accurate, compliant, and current.

→Operational Readiness: Lead change management initiatives, ensuring 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, ensuring that Claims, Provider Relations, IT, and vendors are prepared before rollout.

→Operational Management: Oversee the daily operations of the Payment Integrity Enablement unit. Provide leadership, coaching, and guidance to the team to ensure high performance, accountability, and engagement. Support employee development, reinforce operational standards, and create a collaborative environment that aligns with departmental and organizational goals.

→Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Requirements

~2 min read

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

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