Payment Integrity Program Specialist

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 Program Specialist supports the administration, coordination, and continuous improvement of PacificSource's Payment Integrity program. This role serves as a key operational resource responsible for vendor coordination, implementation support, project tracking, savings monitoring, reporting coordination, documentation management, project coordination, and cross-functional communication. The Program Specialist works closely with Payment Integrity leadership, Claims, Finance, Compliance, Provider Relations, and external vendors to support program effectiveness and successful execution of payment integrity initiatives.

Essential 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 escalate 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.

Supporting Responsibilities:

• 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 operations, project coordination, vendor management, claims administration, payment integrity, or closely related experience required.

Education, Certificates, Licenses: 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. Reporting and documentation management. Microsoft Excel, PowerPoint, and other business productivity tools. Healthcare reimbursement and payment integrity concepts preferred.

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 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.

PacificSource is anything but a typical health insurance company. Founded in 1933, we’re an independent, not-for-profit organization that puts our members, and their communities first—across Idaho, Oregon, Montana, and Washington.

It's our employees who make it happen: promoting health equity and partnering with providers to deliver better access to optimal, affordable care. So yes, with PacificSource, you get to do great things. In our effort to put members first—more than 525,000 of them—initiative, commitment, and hard work are supported and rewarded with excellent benefits, competitive wages, and opportunities for personal growth and advancement.

Benefits: Flexible telecommute policy, medical, vision, and dental insurance, incentive program, paid time off and holidays, 401(k) plan, volunteer opportunities, tuition reimbursement and training, life insurance, and options such as a flexible spending account.

Why PacificSource

We love our common purpose. Empowerment, flexibility, and sharing success make for a great place to work. Here’s what else we feel good about:

• A mission with a real sense of shared values
• Competitive wages and outstanding benefits, including telecommuting
• Opportunities for learning development and career advancement
• Organizational leadership style rooted in servant and transformational leadership
• A commitment to support the communities we serve
• A belief in the importance of work-life balance

Upcoming career fairs and events

• Stay tuned! More to come soon!

Grow your career with us

PacificSource is an equal opportunity employer and a company that loves helping people. We work with our employees to understand their goals, and provide training, individual development, and career advancement opportunities to help them achieve just that.

Recognitions

• Top Workplace 2026, 2025 and 2024 USA | USA Today

• 2025 Healthcare Top Workplaces | Energage Top Workplaces

• # 6 Healthiest Employer of Oregon 2025 | Portland Business Journal

• Top Workplace 2024, 2023 and 2022 for Oregon and SW Washington | The Oregonian

• Top Workplace 2025, 2024, 2023 and 2022 for the Treasure Valley | Idaho Press

• Certified Age Friendly Employer, 2023 | Age Friendly Institute

Affirmative Action Program Policy Statement

PacificSource is an equal opportunity employer. Click here to review our AAP Policy Statement.

Get in touch

If you have questions about working at PacificSource or need help with your application, please email HRrecruiting@PacificSource.com.