Payment Integrity Program Specialist

Job not on LinkedIn

🔥 1 hour ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $56.8k - $96.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 9%

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

• Coordinate day-to-day activities with external payment integrity vendors and business partners • Coordinate and support implementation of payment integrity initiatives, audit programs, recovery projects, and operational enhancements • Track and monitor vendor performance metrics, service level agreements, recoveries, savings, and project milestones • Maintain payment integrity inventories, project plans, work logs, tracking tools, policies, procedures, workflows, and program documentation • Coordinate internal and external meetings, document action items, and monitor follow-up activities • Prepare reports, presentations, and supporting documentation for leadership, committees, and business partners • Support regulatory reporting, audit requests, and documentation requirements • Facilitate communication among Payment Integrity, Claims, Finance, Compliance, Provider Relations, Information Technology, and external vendors • Assist with implementation testing, operational readiness activities, and post-implementation monitoring • Support process improvement initiatives and departmental projects • Monitor project risks, issues, and dependencies and escalate concerns to leadership • Track recoveries, cost avoidance activities, vendor savings, and operational performance metrics • Participate in departmental meetings and represent Payment Integrity on assigned projects and workgroups • Assist with contract, statement of work, and vendor performance document management • Meet department and company performance and attendance expectations • Perform other duties as assigned

🎯 Requirements

• Minimum of 3 years of healthcare operations, project coordination, vendor management, claims administration, payment integrity, or closely related experience required • High school diploma or equivalent required • Bachelor's degree preferred • Knowledge of healthcare operations and claims administration • Knowledge of project coordination and implementation support • Knowledge of vendor management and performance monitoring • Knowledge of reporting and documentation management • Proficiency with Microsoft Excel, PowerPoint, and other business productivity tools • Knowledge of healthcare reimbursement and payment integrity concepts preferred • Ability to follow PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information • Ability to read and comprehend written and spoken English • Ability to communicate clearly and effectively • Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive typing/sorting/filing motions, and lightly lift and carry files and business materials • Ability to travel approximately 5% of the time