Manager, Payment Integrity

Job Listing ID:

4450837

Job Title:

Manager, Payment Integrity Application Deadline:

04/09/2026

Job Location:

Springfield

Date Posted:

03/10/2026

Hours Worked Per Week:

40

Shift:

Day Shift Duration of Job:

Full Time, more than 6 months You may contact this employer directly. (Obtain the contact information to print or add to your jobs.)

Job Summary:

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 Manager of Payment Integrity (PI) leads the strategic design, implementation, and execution of programs aimed at improving payment accuracy and enhancing member affordability. This role serves as a key liaison for reimbursement policy and PI initiatives, ensuring alignment between cost-of-care objectives and departmental priorities through structured governance, ideation, and business case development. The Manager oversees program-level performance tracking to ensure measurable impact and continuous improvement. In close collaboration with Health Care and Finance divisions, this role supports enterprise-wide cost-of-care strategies by identifying operational efficiencies, uncovering savings opportunities, and fostering innovative partnerships that expand the reach and effectiveness of PI initiatives.

Essential Responsibilities:

• Leads the development and execution of enterprise-wide Payment Integrity strategies aligned with financial and operational goals.
• Oversees a comprehensive suite of pre- and post-payment programs-including claims editing, audits, subrogation, readmission reviews, and coordination of benefits-while continuously refining approaches to address evolving trends such as value-based care, regulatory shifts, and emerging fraud schemes.
• Manages external vendors supporting audits, analytics, and fraud detection. Ensures accountability through robust service-level agreements (SLAs), key performance indicators (KPIs), and contract negotiations. Monitors and reports on recovery rates, audit turnaround times, and dispute resolution outcomes.
• Directs Fraud Waste and Abuse (FWA) detection efforts in collaboration with Special Investigations Unit (SIU) and compliance teams. Leverages predictive analytics and rules engines to identify suspicious billing patterns, ensuring timely investigation, documentation, and resolution.
• Ensures compliance with ICD-10, CPT/HCPCS, DRG, and CMS guidelines to To view the full job description please use the link below.

https://www.aplitrak.com/?adid=YmJnZW5lcmljLjQ0MTk1Ljg3NjRAcGFjaWZpY3NvdXJjZWNvbXAuYXBsaXRyYWsuY29t

Job Classification:

Managers, All Other Access our statewide or regional occupation report for more information about wages, employment outlooks, skills, training programs, related occupations, and more. Compensation

Salary:

Depending on Experience Job Requirements

Experience Required:

 At least 1 year

Education Required:

None

Minimum Age:

N/A Gender:

N/A