Payment Integrity Analytics Specialist

PacificSource; North Bend (OR); On-site; USD 57,000 - 97,000; Full time

Job summary

PacificSource is seeking a Payment Integrity Analytics Specialist in Oregon to analyze claims data, develop dashboards, and monitor performance metrics to improve payment integrity, fraud, waste and abuse detection.

You will collaborate with Finance, Compliance, Claims Operations, IT, and external vendors to produce actionable insights, support budgeting and regulatory reporting, and present findings to leadership.

A minimum of 3 years in healthcare analytics or related fields is required.

Qualifications

• Minimum 3 years of healthcare analytics, claims analytics, payment integrity, finance analytics, reimbursement analysis, or closely related experience.
• Knowledge of healthcare claims processing and reimbursement methodologies.
• Experience with data analysis and reporting tools such as SQL, Power BI, or Tableau.

Responsibilities

• Develop and maintain payment integrity dashboards, reports, and performance scorecards.
• Track recoveries, cost avoidance, savings, and operational performance metrics.
• Analyze claims, provider, reimbursement, and audit data to identify payment integrity opportunities.
• Support fraud, waste, and abuse detection through data analysis and reporting.
• Create ad hoc analyses and presentations to support leadership decision-making.

Skills

Healthcare analytics

Data analysis

SQL

Power BI

Tableau

Excel

Reimbursement analysis

Reporting

Education

Bachelor's degree in business, finance, statistics, data analytics, healthcare administration, information systems

High school diploma or equivalent

Tools

Power BI

Tableau

Excel

Job description

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 Analytics Specialist is responsible for data analysis, reporting, savings measurement, recovery tracking, operational performance monitoring, and identification of payment integrity opportunities. This role develops reports, dashboards, and analytical insights that support payment integrity operations, FWA prevention efforts, vendor oversight, and operational decision-making. The Analytics Specialist works closely with Payment Integrity leadership, Claims Operations, Finance, Compliance, Information Technology, and external vendors to transform data into actionable business insights.

Essential Responsibilities

Develop, maintain, and distribute payment integrity dashboards, reports, and performance scorecards. Track and monitor recoveries, cost avoidance, savings, inventory, and operational performance metrics. Analyze claims, provider, reimbursement, and audit data to identify payment integrity opportunities and emerging trends. Support fraud, waste, and abuse detection efforts through data analysis and reporting. Monitor vendor performance and validate reported recoveries, savings, and contractual performance measures. Develop recurring operational, financial, and executive reporting. Perform data validation, reconciliation, and quality assurance activities. Support audit targeting, provider outlier analysis, and recovery opportunity identification. Create ad hoc analyses and presentations to support leadership decision-making. Partner with Information Technology and enterprise data teams to improve reporting capabilities and data accessibility. Identify trends, risks, and opportunities and provide data-driven recommendations to leadership. Assist with budgeting, forecasting, and performance measurement activities related to payment integrity programs. Support regulatory reporting, audits, and documentation requests. Participate in departmental meetings and assigned projects.

Supporting Responsibilities

Participate in compliance and operational initiatives as needed. 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.

SUCCESS PROFILE

Work Experience: Minimum of 3 years of healthcare analytics, claims analytics, payment integrity, finance analytics, reimbursement analysis, or closely related experience required.

Education, Certificates, Licenses

Bachelor's degree in business, finance, statistics, data analytics, healthcare administration, information systems, or related field preferred. High school diploma or equivalent required.

Knowledge

• Healthcare claims processing and reimbursement methodologies.
• Data analysis and reporting techniques.
• Microsoft Excel and reporting tools.
• SQL, Power BI, Tableau, or similar reporting platforms preferred.
• Medicare, Medicaid, Commercial, and Marketplace health plan operations preferred.
• Statistical analysis and performance measurement concepts.

Competencies

Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work

Environment

Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.

Skills

• 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 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.

Physical Requirements

Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer

This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.