Manager, Payment Integrity Enablement

Overview 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! 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. Additional Benefits 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 Key Responsibilities 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 ar