Description review
Manager, Payment Integrity-Clinical experience
Molina Healthcare · United States · back to the listing
HR standards
62/100
needs work
Title ↔ description
71/100
solid
Reads as
Operations Manager
100% confident
What this role officially is
operations manager — ESCO, the EU occupation classification
Operations managers plan, oversee and coordinate the daily operations of production of goods and provision of services. They also formulate and implement company policies and plan the use of human resources and materials.
Also known as: division operations manager, operations administrator, operations supervisor, operations general manager, operations director, business operations manager
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What the listing never says
- 19 bullet points. Long requirement lists deter qualified candidates, who read them as hard gates. Scope clarity
- No pay range published. Candidates cannot tell whether applying is worth their time. Pay transparency
- No location or timezone policy stated, so a candidate cannot tell where they may work from. Scope clarity
The listing, marked up
Nothing in the wording of this listing tripped a check. The scores above still judge how complete and coherent it is.
JOB DESCRIPTION Job SummaryLeads and manages team responsible for payment integrity activities including recovery operations. Responsible for performance, quality levels and establishing procedures and techniques that achieve optimal payment integrity operational standards and production targets.
Essential Job Duties
• Leads and manages day-to-day operations for assigned payment integrity programs, ensuring accuracy, timeliness, and adherence to policies and procedures.
• Hires, trains, and develops staff responsible for inventory management, reporting, data integrity, and recovery performance.
• Implements and monitors quality assurance programs and performance metrics to ensure recovery and cost avoidance targets are met.
• Collaborates with internal departments (Shared Services) to resolve system or process issues impacting payment accuracy.
• Reviews and refines workflows and standard operating procedures to improve efficiency, accuracy, and audit readiness.
• Facilitates meetings with vendors and internal partners to discuss production performance, operational barriers, and process optimization opportunities.
• Analyzes operational data to identify trends, evaluate recovery effectiveness, and propose actionable improvements.
• Supports compliance with CMS and state regulations.
• Contributes to small- to mid-scale projects focused on process improvement, automation, and data accuracy.
• Promotes a culture of accountability, continuous improvement, and professional development within the team.
Required Qualifications
• At least 7 years of experience supporting health care operations, including 4 years payment integrity/claims experience, or equivalent combination of relevant education and experience.
• At least 1 year management/leadership experience.
• Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and customers.
• Strong organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
• Strong verbal and written communication skills.
• Microsoft Office suite and applicable software program(s) proficiency.
Preferred Qualifications
• Managed care payor experience, preferably with Medicare/Medicaid government-sponsored programs.
• Understanding of ICD-9/10CM, MS-, AP- and APR-DRG reimbursement.
• Electronic medical record (EMR) and medical record repository experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Originally posted on Himalayas
Essential Job Duties
• Leads and manages day-to-day operations for assigned payment integrity programs, ensuring accuracy, timeliness, and adherence to policies and procedures.
• Hires, trains, and develops staff responsible for inventory management, reporting, data integrity, and recovery performance.
• Implements and monitors quality assurance programs and performance metrics to ensure recovery and cost avoidance targets are met.
• Collaborates with internal departments (Shared Services) to resolve system or process issues impacting payment accuracy.
• Reviews and refines workflows and standard operating procedures to improve efficiency, accuracy, and audit readiness.
• Facilitates meetings with vendors and internal partners to discuss production performance, operational barriers, and process optimization opportunities.
• Analyzes operational data to identify trends, evaluate recovery effectiveness, and propose actionable improvements.
• Supports compliance with CMS and state regulations.
• Contributes to small- to mid-scale projects focused on process improvement, automation, and data accuracy.
• Promotes a culture of accountability, continuous improvement, and professional development within the team.
Required Qualifications
• At least 7 years of experience supporting health care operations, including 4 years payment integrity/claims experience, or equivalent combination of relevant education and experience.
• At least 1 year management/leadership experience.
• Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and customers.
• Strong organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
• Strong verbal and written communication skills.
• Microsoft Office suite and applicable software program(s) proficiency.
Preferred Qualifications
• Managed care payor experience, preferably with Medicare/Medicaid government-sponsored programs.
• Understanding of ICD-9/10CM, MS-, AP- and APR-DRG reimbursement.
• Electronic medical record (EMR) and medical record repository experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Originally posted on Himalayas