Payment Integrity Program Specialist
$56.78k - $96.53kFull-time
PacificSource
Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. 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. Essential Responsibilities:
Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Compensation Disclaimer The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range. Base Range:
$56,779.86 - $96,525.75 Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
- 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.
Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Compensation Disclaimer The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range. Base Range:
$56,779.86 - $96,525.75 Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
- We are committed to doing the right thing.
- We are one team working toward a common goal.
- We are each responsible for customer service.
- We practice open communication at all levels of the company to foster individual, team and company growth.
- We actively participate in efforts to improve our many communities-internally and externally.
- We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
- We encourage creativity, innovation, and the pursuit of excellence.
Vacancy posted 1 day ago
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