Payment Integrity Analytics Specialist

Join PacificSource and help our members access quality, affordable care!

• →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.

• →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.

Adaptability

Building Customer Loyalty

Building Strategic Work Relationships

Building Trust

Continuous Improvement

Contributing to Team Success

Planning and Organizing

Work Standards

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• 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.