Payment Integrity Analytics Specialist

Job not on LinkedIn

🔥 7 minutes ago

🇺🇸 United States – Remote

💵 $56.8k - $96.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📉 Data Analyst

👻 Ghost score 20%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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PACIFICSOURCE

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

Not-for-profit health plans

📋 Description

• Develop, maintain, and distribute payment integrity dashboards, reports, and performance scorecards • Track and monitor recoveries, cost avoidance, savings, inventory, and operational performance metrics • Analyze claims, provider, reimbursement, and audit data to identify payment integrity opportunities and emerging trends • Support fraud, waste, and abuse detection efforts through data analysis and reporting • Monitor vendor performance and validate reported recoveries, savings, and contractual performance measures • Develop recurring operational, financial, and executive reporting • Perform data validation, reconciliation, and quality assurance activities • Support audit targeting, provider outlier analysis, and recovery opportunity identification • Create ad hoc analyses and presentations to support leadership decision-making • Partner with Information Technology and enterprise data teams to improve reporting capabilities and data accessibility • Identify trends, risks, and opportunities and provide data-driven recommendations to leadership • Assist with budgeting, forecasting, and performance measurement activities related to payment integrity programs • Support regulatory reporting, audits, and documentation requests • Participate in departmental meetings and assigned projects • Participate in compliance and operational initiatives as needed • Perform other duties as assigned • Collaborate with Payment Integrity leadership, Claims Operations, Finance, Compliance, Information Technology, and external vendors

🎯 Requirements

• Minimum of 3 years of healthcare analytics, claims analytics, payment integrity, finance analytics, reimbursement analysis, or closely related experience required • High school diploma or equivalent required • Bachelor's degree in business, finance, statistics, data analytics, healthcare administration, information systems, or related field preferred • Knowledge of healthcare claims processing and reimbursement methodologies • Knowledge of data analysis and reporting techniques • Knowledge of Microsoft Excel and reporting tools • Knowledge of statistical analysis and performance measurement concepts • SQL, Power BI, Tableau, or similar reporting platforms preferred • Medicare, Medicaid, Commercial, and Marketplace health plan operations preferred • Ability to read and comprehend both written and spoken English • Ability to communicate clearly and effectively • Ability to meet department and company performance and attendance expectations • Ability to follow PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information • Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive motions, and light lifting and carrying • Travel required approximately 5% of the time

🏖️ Benefits

• Equal opportunity employment • Work-from-home arrangement • Ergonomically configured equipment • Opportunities to participate in community, social justice, equity, diversity, and inclusion initiatives