Payment Integrity Analytics Specialist
About The Position
The Payment Integrity Analytics Specialist is responsible for data analysis, reporting, savings measurement, recovery tracking, operational performance monitoring, and identification of payment integrity opportunities. This role develops reports, dashboards, and analytical insights that support payment integrity operations, FWA prevention efforts, vendor oversight, and operational decision-making. The Analytics Specialist works closely with Payment Integrity leadership, Claims Operations, Finance, Compliance, Information Technology, and external vendors to transform data into actionable business insights.
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.
- Healthcare claims processing and reimbursement methodologies.
- Data analysis and reporting techniques.
- Microsoft Excel and reporting tools.
- Accountability
- Collaboration
- Communication (written/verbal)
- Flexibility
- Listening (active)
- Organizational skills/Planning and Organization
- Problem Solving
- Teamwork
Nice To Haves
- Bachelor's degree in business, finance, statistics, data analytics, healthcare administration, information systems, or related field preferred.
- SQL, Power BI, Tableau, or similar reporting platforms preferred.
- Medicare, Medicaid, Commercial, and Marketplace health plan operations preferred.
- Statistical analysis and performance measurement concepts.
Responsibilities
- 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.
- Meet department and company performance and attendance expectations.
- Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
- Perform other duties as assigned.
Benefits
- Our Values
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
