Payment Integrity Program Specialist

PacificSource Health Plans

. Coordinate day-to-day activities with external payment integrity vendors and business partners .

Posted 10/8/2026full-timeRemote • Florida • United StatesMid-LevelSenior💰 $56,780 - $96,526 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare operations, project coordination, and vendor management, with a strong focus on payment integrity and compliance. Proficient in tracking performance metrics and facilitating communication among diverse stakeholders.

Highest-signal resume keywords

Healthcare OperationsProject CoordinationVendor ManagementPayment IntegrityReporting and Documentation Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdministrationPerformance MonitoringOperational ReadinessProcess ImprovementAudit Programs

Soft Skills

Clear CommunicationEffective CollaborationProblem-Solving

Tools & Technologies

Microsoft ExcelMicrosoft PowerPointBusiness Productivity Tools

Industry Keywords

HIPAA ComplianceHealthcare ReimbursementPayment Integrity Concepts

About the role

Key responsibilities & impact

Coordinate day-to-day activities with external payment integrity vendors and business partners
Coordinate and support implementation of payment integrity initiatives, audit programs, recovery projects, and operational enhancements
Track vendor performance metrics, service level agreements, recoveries, savings, and project milestones
Maintain payment integrity inventories, project plans, work logs, tracking tools, policies, procedures, workflows, and program documentation
Coordinate 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, documentation requirements, implementation testing, operational readiness, and post-implementation monitoring
Facilitate communication among Payment Integrity, Claims, Finance, Compliance, Provider Relations, Information Technology, and external vendors
Support process improvement initiatives and departmental projects
Monitor project risks, issues, and dependencies and escalate concerns to leadership
Track 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
Perform other duties as assigned

Requirements

What you’ll need

Minimum of 3 years of healthcare operations, project coordination, vendor management, claims administration, payment integrity, or closely related experience required
High school diploma or equivalent required
Bachelor's degree preferred
Knowledge of healthcare operations and claims administration
Knowledge of project coordination and implementation support
Knowledge of vendor management and performance monitoring
Knowledge of reporting and documentation management
Proficiency with Microsoft Excel, PowerPoint, and other business productivity tools
Knowledge of healthcare reimbursement and payment integrity concepts preferred
Ability to follow privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information
Ability to read and comprehend written and spoken English
Ability to communicate clearly and effectively
Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive motions, and lift and carry files and business materials
Ability to travel approximately 5% of the time

Benefits

Comp & perks

Equal opportunity employment
Work-from-home arrangement in Florida
Ergonomically configured equipment
At-will employment