Payment Integrity Program Lead

PacificSource Health Plans; United States; Remote; USD 57,000 - 97,000; Full time

Job summary

PacificSource Health Plans is seeking a Payment Integrity Program Specialist to support administration, coordination, and continuous improvement of the Payment Integrity program. You will work with leadership, Claims, Finance, Compliance, and external vendors to drive program effectiveness.

The role emphasizes vendor coordination, project tracking, reporting, and documentation management, with travel about 5% and a strong focus on collaboration across departments.

Qualifications

• Minimum of 3 years of healthcare operations, project coordination, vendor management, claims administration, payment integrity, or closely related experience required.
• Bachelor’s degree preferred. High school diploma or equivalent required
• Knowledge: Healthcare operations and claims administration. Project coordination and implementation support. Vendor management and performance monitoring.

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.

Skills

Vendor management

Project coordination

Claims administration

Payment integrity

Reporting

Education

Bachelor’s degree preferred

High school diploma or equivalent required

Tools

Microsoft Excel

PowerPoint

Job description

PacificSource Health Plans is seeking a Payment Integrity Program Specialist to support administration, coordination, and continuous improvement of the Payment Integrity program. You will work with leadership, Claims, Finance, Compliance, and external vendors to drive program effectiveness.

The role emphasizes vendor coordination, project tracking, reporting, and documentation management, with travel about 5% and a strong focus on collaboration across departments.