Healthcare Payment Integrity Project Lead

PacificSource Health Plans; Tallahassee (FL); On-site; USD 57,000 - 97,000; Full time

Job summary

PacificSource Health Plans is seeking a Program Specialist to support the Payment Integrity program. You will coordinate with external vendors, assist with new initiatives, and monitor performance metrics and savings opportunities.

You will partner with Claims, Finance, Compliance, and IT, ensuring accurate documentation, reporting, and cross-functional collaboration. A Bachelor’s degree is preferred and healthcare operations experience is valued.

Qualifications

• 3+ years of healthcare operations, project coordination, vendor management, claims administration, payment integrity, or closely related experience.
• Bachelor's degree preferred. High school diploma or equivalent required.
• Knowledge of healthcare operations, claims administration, and reporting concepts is a plus.

Responsibilities

• Coordinate day-to-day activities with external payment integrity vendors and business partners.
• Coordinate and support implementation of payment integrity initiatives and audit programs.
• Track vendor performance metrics, SLAs, recoveries, savings, and milestones.
• Assist with maintenance of inventories, project plans, and tracking tools.
• Prepare reports and supporting documentation for leadership and committees.
• Support regulatory reporting, audits, and policy documentation.
• Maintain payment integrity policies and procedures.

Skills

Accountability

Collaboration

Communication

Flexibility

Listening

Organization & Planning

Problem Solving

Teamwork

Education

Bachelor's degree preferred

High school diploma or equivalent

Job description

PacificSource Health Plans is seeking a Program Specialist to support the Payment Integrity program. You will coordinate with external vendors, assist with new initiatives, and monitor performance metrics and savings opportunities.

You will partner with Claims, Finance, Compliance, and IT, ensuring accurate documentation, reporting, and cross-functional collaboration. A Bachelor’s degree is preferred and healthcare operations experience is valued.