Director, Payment Integrity

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!

The Director of Payment Integrity provides strategic leadership and oversight for all Payment Integrity functions, ensuring payment accuracy, regulatory compliance, and cost containment across IEHP. This role develops and drives the vision and strategy for payment integrity programs and operational excellence. The Director partners across the enterprise to optimize reimbursement, prevent fraud, waste, abuse, and improve member affordability. This role is critical to ensuring the financial sustainability and regulatory compliance of the organization by preventing, identifying, and recovering inappropriate healthcare payments across all lines of business, including Medi-Cal, Medicare Advantage, and Commercial products.

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 & Requirement

• Minimum of seven(7) years of progressive healthcare administration experience in payment integrity, special investigations, or healthcare anti-fraud, inclusive of a minimum of two (2) years of experience with an HMO or managed care experience. Proven leadership experience, mentoring, and developing a team at a leadership level
• Experience in Vendor Partner Oversight; contracting and vendor management of external payment vendors and/or audit firms
  • Preferred: Medi-Cal and/or Medicare claims experience
• Bachelor's degree in Business Administration, Accounting, or Healthcare from an accredited institution required
  • Preferred: Master’s degree in a related field from an accredited institution

Key Qualifications

• Comprehensive knowledge and understanding in the following areas:
  • Rules and regulations governing Medi-Cal benefits and claims adjudication practices and procedures
  • Coding Knowledge for ICD-10, CPT, or Healthcare Common Procedure Coding Syste
  • Principles and techniques of supervision and training
  • Negotiation and relationship management
  • Process improvement and business process design
• Data entry involving computer keyboards and screens
• Skill in word processing and presentation software
• Microcomputer literacy preferred
• Advanced skill in project management
• Proficiency in spreadsheet, statistical analysis, query / data mining, and business intelligence software
• Proven ability to:
  • Maintain confidentiality and privacy
  • Communicate professionally to both internal and external stakeholders
  • Establish, contribute, and maintain a positive and productive work environment
  • Plan, organize, and manage the work of all assigned personnel
    

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

Pay Range

• $154,128.00 USD Annually - $204,214.40 USD Annually