Lead Payment Integrity Systems Specialist

This is a fully remote position, open to applicants in Florida, +3 more states.

📋 Description

• Act as the primary individual contributor and enterprise-level authority on Payment Integrity systems, platform governance, analytics, financial reporting, and operational visibility.

• Direct enterprise-wide analysis of Payment Integrity systems, claims, workflows, financial data, and reporting metrics.

• Identify strategic risks, make prioritization decisions, uncover savings opportunities, and provide recommendations for operational enhancements.

• Establish standards for technical reviews, data validation processes, dashboard creation, reporting routines, ServiceNow intake, defect/enhancement prioritization, UAT/release readiness, post-release issue tracking, and operational visibility.

• Function as the senior business-technology liaison for managing platform changes.

• Coordinate alignment among Operations, Technology, Finance, governance, and leadership stakeholders regarding scope, impact, risks, decisions, and readiness.

• Oversee operating routines related to incidents, defects, enhancements, releases, automation opportunities, and modernization initiatives.

• Convert complex cross-platform results into executive-ready summaries, strategic recommendations, implementation plans, and measurable success criteria.

• Counsel leadership on platform governance, financial reporting, data quality controls, process standardization, and long-term system capability requirements.

• Drive continuous improvement of methodologies, standards, and job-family consistency across Payment Integrity system support and analytics functions.

• Provide technical leadership, coaching, peer reviews, and escalation support for PI Systems Specialist I, II, and Senior PI Systems Specialist team members.

• Perform additional duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• A Bachelor's Degree in healthcare, business, finance, accounting, information systems, data analytics, or a related field, or equivalent experience is required.

• A minimum of 5 years of relevant experience in Payment Integrity systems, managed care claims systems, platform governance, financial reporting, healthcare analytics, business analysis, UAT/release readiness, or a related technical healthcare role is required.

• Required specialized expertise in Payment Integrity systems, claims data, operational workflows, data governance, financial reporting, system dependencies, and cross-functional transformations.

• Advanced proficiency in SQL, reporting/analytics tools such as Power BI, financial reporting tools, Excel, ServiceNow or similar ticketing/workflow platforms, and executive-level data storytelling is required.

• Proven ability to lead technical directions, resolve precedent-setting issues, influence without formal authority, and communicate effectively with senior leaders is required.

• Platform Support & Governance is required.

• Data Validation & Reporting is required.

• UAT / Regression Testing is required.

• Defect & Enhancement Intake is required.

• Release Readiness is required.

• Financial Systems / Reporting is required.

• Dashboard / KPI Development is required.

• Configuration & Edit Support is required.

• Related Payment Integrity systems and technology support functions are required.

• Advanced knowledge of financial systems and accounting principles is preferred.

• Experience in establishing platform governance, operational visibility standards, dashboard/reporting strategies, release-readiness routines, and cross-functional technology operating models is preferred.

• Advanced credentials in data analytics, business analysis, healthcare data, project/program management, Lean Six Sigma, finance/accounting, SQL, or related systems disciplines are preferred.

• Certifications such as LPN, RN, CPC, CPC-H, CPC-P, CCS, CCS-P, RHIT, RHIA, CPMA, CIC, or CCDS are preferred.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K and stock purchase plans available.

• Tuition reimbursement offered.

• Paid time off along with holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional incentive programs may be included in total compensation.

• Equal opportunity employer dedicated to diversity.