Integrity Analytics Specialist

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.

• Participate in compliance and operational initiatives as needed.
• Meet department and company performance and attendance expectations.
• Follow the Pacific Source privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

• 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:
• 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

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.

• 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.

This job description indicates the general nature and level of work performed by employees within this position and is subject to…