Position Purpose: The Payment Integrity Systems Specialist II performs moderately complex Payment Integrity systems, data, reporting, and workflow analysis. The role supports platform enhancements, defect remediation, reporting routines, UAT/release readiness, financial and operational data validation, and cross-functional follow-up across Operations, Technology, Finance, and governance stakeholders.
- Conduct moderately complex analysis of Payment Integrity platform outputs, claims system data, edit/rule behavior, financial/reporting outputs, and workflow performance to identify exceptions, trends, and operational impacts.
- Manage moderately complex ServiceNow or similar incidents, defects, enhancement requests, and intake items by documenting requirements, tracking status, coordinating follow-up, and escalating blockers.
- Coordinate UAT, regression testing, validation, and release-readiness activities for system changes, including defect validation and communication of operational impacts.
- Develop and maintain dashboards, trackers, recurring reports, and workstream visibility tools for platform enhancements, defects, metrics, savings opportunities, and operational improvement initiatives.
- Gather and analyze data using Excel, SQL, Power BI, financial reporting tools, or approved reporting platforms to validate outputs and support decision-making.
- Partner with Operations, Technology, Finance, governance/delivery, and business stakeholders to clarify requirements, document decisions, and support transformation workstreams.
- Apply consistent standards and methodologies to improve data quality, documentation, process consistency, and operational readiness.
- May provide informal guidance or onboarding support to less-experienced team members.
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience: Bachelor's degree in healthcare, business, finance, accounting, information systems, data analytics, or a related field, or equivalent experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
2+ years of relevant experience in Payment Integrity systems, managed care claims systems, data analytics, financial reporting, business analysis, platform support, quality assurance, UAT, or related technical healthcare function. required.
Working knowledge of managed care claims, Payment Integrity concepts, system workflows, reporting, and operational controls. required.
Experience with ticketing, UAT/testing documentation, dashboards, workflow tracking, data validation, and cross-functional issue resolution. required.
Working proficiency with Excel and developing proficiency with SQL, Power BI, financial reporting tools, or similar data/reporting platforms. required.
Platform Support & Governance required.
Data Validation & Reporting required.
Defect & Enhancement Intake required.
UAT / Regression Testing required.
Release Readiness required.
Financial Systems / Reporting required.
Dashboard / KPI Development required.
Configuration & Edit Support required.
Related Payment Integrity systems and technology support functions required.
Experience with Payment Integrity platforms, claims systems, ServiceNow, Power BI, edit/rule configuration, workflow automation, or platform modernization workstreams. preferred.
Working knowledge of financial systems, accounting principles, and operational financial reporting preferred. preferred.
License/Certification:
- Credentials or training in Power BI, SQL, business analysis, Lean Six Sigma, healthcare data analytics, project coordination, or coding/claims concepts where relevant. preferred
- LPN, RN, CPC, CPC-H, CPC-P, CCS, CCS-P, RHIT, RHIA, or CPMA. RHIT, CCS, CIC, CCDS. preferred
Pay Range: $63,600.00 - $114,600.00 per year
