Payment Integrity Program Specialist

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

📋 Description

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

• Manage and assist in the execution of payment integrity initiatives, audit programs, recovery projects, and operational improvements.

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

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

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

• Prepare reports, presentations, and supporting documentation for leadership, committees, and business partners.

• Assist with regulatory reporting, audit requests, and documentation needs.

• Facilitate effective communication among Payment Integrity, Claims, Finance, Compliance, Provider Relations, Information Technology, and external vendors.

• Aid in implementation testing, operational readiness tasks, and post-implementation evaluations.

• Contribute to process improvement initiatives and departmental projects.

• Track project risks, issues, and dependencies, and escalate any concerns to leadership.

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

• Attend departmental meetings and represent Payment Integrity on designated projects and workgroups.

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

• Meet departmental and company performance and attendance standards.

• Execute other duties as assigned.

⛳️ 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.

• A high school diploma or equivalent is required.

• A bachelor's degree is preferred.

• Familiarity with healthcare operations and claims administration is necessary.

• Understanding of project coordination and implementation support is essential.

• Knowledge of vendor management and performance monitoring is required.

• Proficiency in reporting and documentation management is needed.

• Strong skills in Microsoft Excel, PowerPoint, and other business productivity tools are essential.

• Knowledge of healthcare reimbursement and payment integrity concepts is preferred.

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

• Capability to read and comprehend written and spoken English effectively.

• Excellent communication skills are required.

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

• Willingness to travel approximately 5% of the time.

🏝️ Benefits

• Comprehensive health insurance packages.

• Generous paid time off and holiday benefits.

• Retirement savings plans with company matching.

• Opportunities for professional development and growth.

• Supportive work environment that values diversity and inclusion.