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 0%

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 Health Plans

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

PacificSource Health Plans is a healthcare provider that offers a range of health insurance solutions, including plans for individuals, families, and employers. Their offerings include Medicare and Medicaid plans, dental coverage, and administrative services for small and large groups. Committed to member care, PacificSource emphasizes customer service and provides various resources for health management, including mental health support and wellness programs.

📋 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 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 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, documentation requirements, implementation testing, operational readiness, and post-implementation monitoring • Facilitate communication among Payment Integrity, Claims, Finance, Compliance, Provider Relations, Information Technology, and external vendors • 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 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 motions, and lift and carry files and business materials • Ability to travel approximately 5% of the time

🏖️ Benefits

• Equal opportunity employment • Work-from-home arrangement in Florida • Ergonomically configured equipment • At-will employment