Payment Integrity Program Specialist

This is a fully remote position, open to applicants in Florida.

📋 Description

• Oversee daily operations in collaboration with external payment integrity vendors and business partners.

• Facilitate the execution of payment integrity programs, audit activities, recovery initiatives, and operational improvements.

• Monitor vendor performance metrics, service level agreements, recoveries, savings, and project milestones.

• Maintain comprehensive records of payment integrity inventories, project plans, work logs, tracking tools, policies, procedures, workflows, and program documentation.

• Organize meetings, document action items, and track follow-up activities.

• Create reports, presentations, and necessary documentation for leadership, committees, and business partners.

• Assist with regulatory reporting, audit requests, documentation needs, implementation testing, operational readiness, and post-implementation monitoring.

• Promote communication between Payment Integrity, Claims, Finance, Compliance, Provider Relations, Information Technology, and external vendors.

• Contribute to process improvement initiatives and departmental projects.

• Monitor project risks, issues, and dependencies while escalating concerns to leadership.

• Track recoveries, cost avoidance efforts, vendor savings, and operational performance metrics.

• Engage in departmental meetings and represent Payment Integrity in assigned projects and workgroups.

• Assist in managing contracts, statements of work, and vendor performance documentation.

• Meet departmental and organizational performance and attendance standards.

• Execute additional duties as required.

⛳️ Requirements

• A minimum of 3 years of experience in healthcare operations, project coordination, vendor management, claims administration, payment integrity, or a closely related field is required.

• High school diploma or equivalent is required.

• A Bachelor's degree is preferred.

• Familiarity with healthcare operations and claims administration.

• Understanding of project coordination and implementation support.

• Experience in vendor management and performance monitoring.

• Knowledge of reporting and documentation management.

• Proficiency in Microsoft Excel, PowerPoint, and other business productivity tools.

• Preferred knowledge of healthcare reimbursement and payment integrity concepts.

• Ability to adhere to privacy policies and HIPAA laws and regulations regarding confidentiality and security of protected health information.

• Capable of reading and comprehending written and verbal English.

• Strong communication skills, both clear and effective.

• Ability to stoop, bend, sit, and/or stand for prolonged periods, perform repetitive motions, and lift and carry files and business materials.

• Willingness to travel approximately 5% of the time.

🏝️ Benefits

• Equal opportunity employment.

• Work-from-home flexibility in Florida.

• Ergonomically designed equipment.

• At-will employment.