Payment Integrity Project Specialist

Payment Integrity Project Specialist

Hybrid (Onsite Cadence: Tuesday, Wednesday, Thursday.) Out of state not required to come on site.

Ensuring adherence to the Project Management methodology and quality standards, oversees various high-priority projects of mid to large size requiring considerable resources and high levels of functional integration. Responsible for assembling technical and operational project team members, coordinating activities, assigning individual responsibilities, identifying appropriate resources needed, and developing schedules to ensure timely completion of a project. Takes projects from original concept through final implementation. Able to grasp concepts required to understand the overall project scope, and to communicate effectively with project team members, end users and external resources. Manages the integration of vendor tasks and deliverables. Competent to work at the highest levels of all phases of project leadership. Regularly provides guidance, direction and training to less experienced Project Managers.

• Oversees highly complex projects/programs with appropriate departmental and leadership relationship management, and project management. Responsible for the management of multiple projects: Develops project plans, budgets and schedules. Coordinates project work, and completes projects on time and within budget. Works with/leads the constituent Project Managers/workgroup leads responsible for the execution of their areas of a project to monitor cost, schedule and technical performance of component project and operation, while working to ensure the ultimate success of the program. Acts as a mentor and/or consultant to others.
• Assesses resource requirements for projects and negotiates for resources with management to meet project plan deliverables. Organizes and works with appropriate leadership, departments and leaders to plan and schedule the coordination of people and tasks as needed to accomplish project objectives.
• Appropriately manages vendors from initial contracting through project completion. Serves as the leader for assignment of work activities, escalation of project related issues, service delivery, and customer satisfaction. Able to coordinate activities of numerous, diverse areas simultaneously.
• Serves as a liaison for projects between various departments within Corewell Health. Communicates, collaborates, networks with and acts as a consultant to stakeholders and business partners in order to ensure continuity and coordination of services and appropriate utilization of resources.
• Analyzes and documents processes, procedures and outcomes to seek continuous improvement.
• Ensures adherence to the Corewell Health Project Management methodology and quality standards. Acts as a change agent to advance the knowledge and use of project management and the Corewell Health project management methodology and toolset.

• Required Bachelor's Degree or equivalent
• Preferred Master's Degree or equivalent
• 3 years of relevant experience in the field Required
• 5 years of relevant experience in the field Preferred
• Experience in a project management role that adheres to Project Management Institute (PMI) principles and practices, and which includes: leading multiple moderately-sized project teams of eight or more team members within a matrix organization; supervising or leading resources directly or indirectly in a cross-functional team environment; and projects in multiple technologies and/or business functions Preferred
• CRT-Project Management Professional (PMP) - PMI Project Management Institute preferred Or
• CRT-Program Management Professional (PgMP) - UNKNOWN Unknown preferred

Must Have

• Claims/Healthcare
• Influencing role
• Project management of large scale complex implementations.
• SLA agreements.

Nice To Have

• Clinical editing.
• CMS
• Medical Coding
• Payment integrity.

Everforth Apex is a world-class IT services company that serves thousands of clients across the globe. When you join Everforth Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRateds Best of Staffing® in Talent Satisfaction in the United States and Great Place to Work® in the United Kingdom and Mexico.

Everforth Apex uses a virtual recruiter as part of the application process. By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from Everforth Apex and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy at

Everforth Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Everforth Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Everforth Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Everforth Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our 'Welcome Packet' as well, which an Everforth Apex team member can provide.

Everforth Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Everforth Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law.

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