Payment Integrity Program Specialist
About The Position
The Payment Integrity Program Specialist supports the administration, coordination, and continuous improvement of PacificSource's Payment Integrity program. This role serves as a key operational resource responsible for vendor coordination, implementation support, project tracking, savings monitoring, reporting coordination, documentation management, project coordination, and cross-functional communication. The Program Specialist works closely with Payment Integrity leadership, Claims, Finance, Compliance, Provider Relations, and external vendors to support program effectiveness and successful execution of payment integrity initiatives.
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
- Healthcare operations and claims administration.
- Project coordination and implementation support.
- Vendor management and performance monitoring.
- Reporting and documentation management.
- Microsoft Excel, PowerPoint, and other business productivity tools.
- Accountability
- Collaboration
- Communication (written/verbal)
- Flexibility
- Listening (active)
- Organizational skills/Planning and Organization
- Problem Solving
- Teamwork
Nice To Haves
- Bachelor's degree preferred.
- Healthcare reimbursement and payment integrity concepts preferred.
Responsibilities
- Coordinate day-to-day activities with external payment integrity vendors and business partners.
- Coordinate and support implementation of new payment integrity initiatives, audit programs, recovery projects, and operational enhancements.
- Track and monitor vendor performance metrics, service level agreements, recoveries, savings, and project milestones.
- Assist with maintenance of payment integrity inventories, project plans, work logs, and tracking tools.
- 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.
- Maintain payment integrity policies, procedures, workflows, and program documentation.
- Facilitate communication between 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 as appropriate.
- Assist with tracking 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.
- 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
Stand Out From the Crowd
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
