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Director, Payment Integrity (Pre-Pay Edits) - REMOTE

Molina Healthcare

Remote · USJob$97–190K/yrSeen todaySeen in employer's feed today

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At a glance

Compensation
$97–190K/yr
Location
Remote · US
Work Authorization
Not specified

Olive lists jobs from US employers, including remote roles you can work from the United States.

Job overview

The Director leads teams responsible for payment integrity activities, including recovery operations, and sets procedures and performance standards. The role directs enterprise payment integrity programs and initiatives, partners with executive leadership and shared services, and oversees vendors, analytics, and leadership development. Candidates need health care operations and payment integrity or claims experience, management experience, and proficiency with Microsoft Office and applicable software.

Skills & qualifications

RequiredNice to have

Skills

Managed Care Payor OperationsPayment IntegrityClaimsManagementLeadershipWork RelationshipsOrganizationTime ManagementProject ManagementVerbal CommunicationWritten CommunicationMicrosoft OfficeApplicable SoftwareICD-9/10CMMS-DRG ReimbursementAP-DRG ReimbursementAPR-DRG ReimbursementElectronic Medical RecordsMedical Record Repositories

Qualifications

8+ Years Health Care Operations5+ Years Payment Integrity or Claims3+ Years Management or LeadershipMedicare or Medicaid Experience

Full job description

Job Summary

Leads and directs 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

  • Develops and executes the strategic roadmap for payment integrity functions, ensuring alignment with enterprise objectives and regulatory standards.

  • Oversees multiple program areas (e.g., COB, subrogation, data mining, pre-pay edits, PI disputes) and ensures consistent governance, methodology, and performance management across markets.

  • Leads enterprise projects and large-scale initiatives that drive financial improvement, cost containment, and operational transformation.

  • Partners with executive leadership and shared services functions to integrate payment integrity objectives into corporate planning, rate setting, and compliance frameworks.

  • Establishes departmental goals, KPIs, and performance reporting mechanisms that measure and communicate enterprise payment integrity outcomes.

  • Provides subject matter expertise across claims processing, configuration logic, audit readiness, and vendor governance to ensure accuracy and scalability.

  • Represents Payment Integrity at enterprise governance meetings, shared services councils, and external regulatory discussions.

  • Oversees vendor selection, contracting, and ROI management to maximize recovery efficiency and ensure long-term value creation.

  • Champions innovation through automation, advanced analytics, and data-driven decision-making.

  • Mentors leaders and develops succession pipelines, building organizational capability and leadership readiness.

Required Qualifications

  • At least 8 years of experience supporting health care operations, including 5 years payment integrity/claims experience, or equivalent combination of relevant education and experience.

  • At least 3 years management/leadership experience.

  • Managed care payor experience, preferably in Medicare/Medicaid government-sponsored programs.

  • 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.

  • Excellent verbal and written communication skills.

  • Microsoft Office suite and applicable software program(s) proficiency.

Preferred Qualifications

  • 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

Pay Range: $97,299 - $189,732 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

How this job compares

Set against the 1,043 open Healthcare Operations jobs on Olive Jobs, counted November 5, 2026.

Pay
  • This posting$97–190K/yr
  • US median$99–158K/yr539 salary ranges

This range's midpoint, $144K, is 7% above the US median midpoint ($134K) — in the middle half of Healthcare Operations salary ranges across the US.

Openings
Olive Jobs lists 20 open Healthcare Operations jobs in Washington and 1,043 across the US. 8% of them nationwide are listed as remote or flexible.
Hiring the most in Washington
Experience
This posting asks for at least 8 years of experience — more than three in four Healthcare Operations postings that state a minimum ask for (median 5 years, across 873 postings).
Education
334 of the 1,043 open Healthcare Operations jobs (32%) ask for a bachelor's degree or higher.

Counted across the open, public US postings on Olive Jobs on November 5, 2026. Pay medians are the middle values of the low ends and of the high ends of postings that list both ends of a range in the same cadence (a yearly salary or an hourly rate); a range's midpoint is halfway between its ends. Pay and experience figures resting on fewer than 20 postings are left out.

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