Payment Integrity Program Coordinator

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

Job summary

PacificSource Health Plans in Boise, Idaho, is seeking a Payment Integrity Program Specialist to support administration, coordination, and improvement of the Payment Integrity program. You will coordinate with external vendors, track milestones, and help produce reports for leadership.

This role partners with Claims, Finance, Compliance, and Provider Relations to drive program effectiveness, ensure regulatory readiness, and monitor cost savings initiatives.

Qualifications

• Minimum of 3 years in healthcare operations, project coordination, vendor management, claims administration, payment integrity, or closely related experience.
• Bachelor’s degree preferred; high school diploma or equivalent required.
• Experience with vendor management, claims administration, and payment integrity.

Responsibilities

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

Skills

Accountability

Collaboration

Communication

Flexibility

Listening

Organization

Planning

Problem Solving

Teamwork

Education

Bachelor's degree

High school diploma

Tools

Microsoft Excel

PowerPoint

Job description

PacificSource Health Plans in Boise, Idaho, is seeking a Payment Integrity Program Specialist to support administration, coordination, and improvement of the Payment Integrity program. You will coordinate with external vendors, track milestones, and help produce reports for leadership.

This role partners with Claims, Finance, Compliance, and Provider Relations to drive program effectiveness, ensure regulatory readiness, and monitor cost savings initiatives.