Payment Integrity Analytics Specialist

PacificSource; Springfield (OR); Presencial; USD 57.000 - 97.000; Jornada completa

Descripción de la vacante

PacificSource is seeking an experienced healthcare analytics professional to develop and maintain payment integrity dashboards, reports, and scorecards. You will analyze claims data, monitor recoveries, and support fraud detection while partnering with IT and data teams to enhance reporting capabilities.

Ideal candidates have 3+ years in healthcare analytics or related fields, a bachelor's degree in a related area, and strong skills in SQL, Power BI, and Excel.

Formación

• Minimum 3 years of healthcare analytics, claims analytics, payment integrity, finance analytics, reimbursement analysis, or closely related experience.
• Bachelor's degree preferred; high school diploma or equivalent required.

Responsabilidades

• 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.

Conocimientos

Accountability

Collaboration

Communication

Flexibility

Listening

Organizational skills

Planning and Organization

Problem Solving

Teamwork

Educación

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

High school diploma or equivalent

Herramientas

SQL

Power BI

Tableau

Excel

Descripción del empleo

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.

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 Standards

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 live and breathe our values. In fact, our culture is driven by these seven