Manager, Payment Integrity Enablement

IEHP

Payment Integrity Enablement Manager improving billing accuracy and compliance for Inland Empire Health Plan. Leading provider education, coding initiatives, risk tracking, and operational performance.

Posted 8/20/2026full-timeRancho Cucamonga • California • 🇺🇸 United StatesSeniorLead💰 $104,042 - $137,842 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Payment Integrity Enablement, focusing on coding accuracy, compliance with federal and state regulations, and effective training delivery for healthcare providers. Proven ability to lead teams, develop strategic plans, and implement continuous improvement initiatives in healthcare payment integrity.

Highest-signal resume keywords

Healthcare Payment IntegrityICD-10/CPT CodingCertified Professional Coder (CPC)Training Delivery and DevelopmentLeadership and Team Development

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Coding AccuracyRegulatory ComplianceKPI Development and TrackingRisk AssessmentProject ManagementData AnalysisChange ManagementQuality ReviewBilling RegulationsFraud, Waste, and Abuse (FWA) Prevention

Soft Skills

Communication SkillsAnalytical Problem-SolvingInterpersonal SkillsConflict ResolutionTeamwork

Tools & Technologies

Microsoft Office SuiteSQLBI ToolsData Mining Platforms

Certifications & Qualifications

Certified Professional Coder (CPC)Certified Healthcare Auditor (CHA)Certified Coding Specialist (CCS)Project Management Professional (PMP)

Industry Keywords

Managed Care OperationsRevenue Cycle ManagementHealthcare AdministrationBilling StandardsProvider Relations

Tech Stack

Tools & technologies

PMPSQL

About the role

Key responsibilities & impact

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
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
Establish frameworks to identify and assess enablement risks such as coding gaps, provider misunderstanding, and emerging regulatory vulnerabilities
Escalate significant findings to Payment Integrity leadership, SIU/FWA, or Compliance and collaborate with cross-functional partners on remediation and continuous improvement
Monitor and interpret federal/state regulations, including CMS and DHCS, to guide training and educational materials for accurate billing, coding, and reimbursement practices
Develop and track 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
Assess root causes of payment errors and incorporate findings into training programs to resolve recurring trends
Collaborate with SIU/FWA leadership and analytics teams to identify high-risk provider patterns and adjust enablement programs
Partner with Claims, Provider Relations, and external vendors on payment integrity guidelines
Develop communication plans for billing changes, regulatory shifts, and new payment integrity expectations
Establish standardized workflows, documentation, quality review expectations, and version control for training materials, job aids, policies, and curricula
Lead change management and operational readiness initiatives for new billing standards, regulatory updates, and Payment Integrity policies
Oversee daily operations of the Payment Integrity Enablement unit
Provide leadership, coaching, and guidance to the team; support employee development and reinforce operational standards
Perform other duties required to support Health Plan operations and department business needs

Requirements

What you’ll need

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
Proven ability to work collaboratively and influence across multiple functional areas
Proven ability to guide and support team members
Proven ability to work effectively with cross functional partners to navigate workflows and resolve issues
Proven ability to balance day-to-day oversight with longer term strategic improvements
Proven ability to manage multiple priorities while maintaining attention to detail and compliance standards
Some travel involved to conduct training with providers onsite, as needed

Benefits

Comp & perks

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