Payment Integrity Specialist Job at Personify Health

Clinical Content Specialist - Drugs & Biologicals - Payment Integrity

The Clinical Content Specialist – Pharmacy will be responsible for developing an...

Location

India , Bengaluru

Salary:

Not provided

Randstad

Expiration Date

July 16, 2026

Requirements

Passionate about working in the pharmacy and clinical domain, with a focus on learning and growth
Should be passionate about pharmacy and the clinical side
Strong foundation in pharmacy and clinical concepts, including drugs and biologics
Demonstrated experience in research work, college thesis, or complex case study analysis
Strong research mindset with the ability to interpret clinical and medical literature
Excellent communication, articulation, and interpretation skills
Ability to translate complex clinical information into clear and structured insights
Sound clinical knowledge with attention to detail and accuracy
Pharm.D (Doctor of Pharmacy) – Preferred (Priority)
M.Pharm – Pharmacology / Clinical Pharmacy

Job Responsibility

Requires a deep understanding of Pharmacy, Clinical aspects
Good understanding of Drugs and Biologicals and their classification
Awareness of Pharmacy regulatory bodies, like CDSCO, DCGI, DoP
Generic and Brand drugs awareness
Dosage determination, medical necessity, safety and compliance
Dosage and Administration
Medical Necessity
Frequency of Medication
Contraindication
Age/Gender

Fulltime

Ccc Specialist (Payment)

Responsible for all operations for the payment gateways and payment methods, lik...

Location

Thailand , Samut Prakan

Salary:

Not provided

IKEA

Expiration Date

Until further notice

Requirements

Excellent understanding of IKEA payment and refund processes
Experience of problem solving and conflict handling techniques
Customer-focused mindset
Good understanding of all CCC performance KPIs and broader Customer Experience related metrics
Broad knowledge on national regulation and legislation related to payment processes
Broad knowledge of payment methodologies, compliances and industry standards
Strong ability to analyse data related to customer payment and refund experience and turn into actionable insights
Good communication and presentation skills
Ability to bring problems to a resolution independently and within a close team
Ability to comply with the external legal framework and follow internal rules/instructions

Job Responsibility

Responsible for all operations for the payment gateways and payment methods, like processing refunds and any other daily operational tasks related to payments
Responsible for ticket management (monitoring and follow up) with IT, business partners and stakeholders, investigate and escalate issues related to payment or eTax where appropriate
Actively support for troubleshooting within ticket management process, first point of contact for our IT partners to troubleshoot issues and communicating to the respective business owners and development partners
Proactively analyse and report anomalies in customer complaints and support actions for investigations, related to fraud, chargebacks, risk management success factors and other key performance indicators as required, for ensuring accuracy, quality of data and minimise the losses of profitability
Support the invoicing process in collaboration with finance and investigate if applicable
Payment investigations for payments issues, like double payments, missing refunds
Support operational tasks coming from new payment implementations and developments
Responsible as payment super user, to contribute to tests for new development, and training other super users/co-workers and stakeholders on payment processes
Responsible for the alignment with payment vendors on operational actions
Responsible in overseeing and evaluating the payment transaction experience of our customers and contribute in identifying any improvement opportunities to elevate the standards by actioning or communicate findings to relevant stakeholders via the adequate channels

Fulltime

Payment Integrity Nurse Coder RN III

The Payment Integrity Nurse Coder RN III is responsible for investigating, revie...

Location

United States , Los Angeles

Salary:

102183.00 - 163492.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
At least 8 years of clinical RN experience
At least 3 years of experience in utilization management or clinical coding
Investigation and/or auditing experience
Knowledge in CPT, HCPCS, ICD-9, ICD-10, Medicare, and Medicaid rules and regulations
Knowledge of healthcare reimbursement concepts, health insurance business, industry terminology, and regulatory guidelines
Working knowledge of claims coding and medical terminology
Solid understanding of standard claims processing systems and claims data analysis
Strong project leadership and management skills required
ability to prioritize, plan, and handle multiple tasks/demands simultaneously

Job Responsibility

Investigating, reviewing, and providing clinical and/or coding expertise/judgement in the application of medical and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects
Serving as a subject matter expert (SME), performing medical records reviews to include quality audits as well as validation of accuracy and completeness of all coding elements
Providing guidance related to Payment Integrity initiatives to include concept and cost avoidance development
Training and mentoring Payment Integrity Nurse Coder, RN staff
Acting as a Subject Matter Expert, serving as a resource and mentor for other staff
Performing Quality Audits to include validation of accuracy and completeness of ICD, Rev Code, CPT, HCPCs, APR, DRG, POA, and all relevant coding elements
Serving cross functionally with Utilization Management, Medical Directors, and other internal teams to assist in identification of overpayments as well as other projects
Serving as SME for all Payment Integrity functions to include both Retrospective Data Mining as well as Pre-Payment Cost Avoidance
Identifying trends and patterns with overall program and individual provider coding practices
Supporting the creation and execution of strategies that determine impact of opportunity and recover overpayments as well as prospective internal controls preventing future overpayments

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Payment Operation Specialist

We are seeking a highly skilled and motivated Payments Operations Specialist wit...

Location

Salary:

Not provided

Global-e

Expiration Date

Until further notice

Requirements

At least 2+ years of hands-on experience in payment flows and payment operations (mandatory)
Bachelor's degree in industrial engineering, Business Administration, Economics, or a related field
Strong experience with SQL and Excel
Familiarity with payment gateways, APIs, and integration flows
Experience with BI tools (e.g., QlikSense) – advantage
Strong analytical and problem-solving skills with high attention to detail
Ability to work independently and manage multiple tasks in a dynamic environment
Excellent verbal and written communication skills

Job Responsibility

Support daily operations of payment products, ensuring smooth functionality and optimal performance
Investigate and resolve payment-related issues across gateways, acquirers, and payment methods
Analyze payment data to identify trends, anomalies, and improvement opportunities (e.g., declines, approval rates)
Collaborate with cross-functional teams (Product, R&D, Finance, NOC) to resolve escalations and improve processes
Work closely with external partners (PSPs, acquirers and alternative payment providers) to ensure seamless operations and efficient issue resolution
Support and monitor payment integrations, including API-based flows, ensuring correct implementation and ongoing stability
Assist in managing payment flows, including authorization, capture, refunds, and 3DS authentication
Contribute to process improvements and automation initiatives to enhance efficiency

New

Hd Specialist

An HD Specialist promotes and sells dialysis machines, consumables, and related ...

Location

Philippines , Muntinlupa City

Salary:

Not provided

FMS USA Fresenius Mgmt Services Inc

Expiration Date

Until further notice

Requirements

bachelor's degree in Business, Management, Sales, Marketing, or its equivalent
high medical knowledge and selling skills
excellent communication skills - both written and verbal including the English language
proven track record in sales, preferably in the medical devices or pharmaceutical industry
commitment to drive results, integrity, adaptability and resilience

Job Responsibility

Present and sell hemodialysis products to current and potential clients
develop and maintain sales materials and current product knowledge
communicate and collaborate with your line manager on goals
foster strong relationships with Doctors, Nurses, and key people to encourage and promote the use of our products
build close ties with the decision-makers of hospitals/centers to ensure continued usage of our products
service existing clients and expand territory by creating new accounts
achieve and hit (if possible, exceed) monthly, quarterly, and annual targets
identify and resolve client concerns
prepare various status reports (Itinerary, Monthly Activity Report, Census Report)
participate in marketing events such as seminars, conventions, and the like

What we offer

Competitive Base Pay
Guaranteed 13th Month Pay
Mandatory SSS, Pag-ibig and Philhealth Benefits
Allowances
Comprehensive HMO, Group Life, and Personal Accident Insurance Coverage
Retirement Program
Vacation and Sick Leave Credits
Annual Physical Examination and Vaccination Program
Performance-Based Incentives
Career Development Opportunities

Fulltime

New

Senior Payroll Specialist

We are looking for a Senior Payroll Specialist to join a popular organization in...

Location

United States , Portland

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Demonstrated experience managing full-cycle payroll in a high-volume environment supporting more than 500 employees
Strong background in multi-state payroll administration with knowledge of union payroll practices
Advanced hands-on experience with UKG Pro
Familiarity with timekeeping systems, with UKG timekeeping experience preferred
Proven ability to audit payroll inputs, resolve discrepancies, and maintain a high level of accuracy under tight deadlines
Proficiency in Excel for reconciliations, reporting, and payroll analysis
Strong understanding of payroll compliance, deductions, garnishments, and final pay processing

Job Responsibility

Administer bi-weekly payroll for approximately 800 employees, ensuring accurate pay for hourly, salaried, union, and multi-state team members
Reconcile payroll data by reviewing pre-processing reports, validating totals, and preparing summary analysis using Excel
Examine weekly time records, identify inconsistencies, and work closely with leaders to correct issues before payroll is finalized
Maintain payroll-related timekeeping data, helping support system setup and integrations that improve the quality of incoming payroll information
Update employee compensation records, including rate changes, retroactive adjustments, and prior-period time corrections
Oversee garnishment processing, union-related payments, and associated reporting and remittance activities
Execute off-cycle payroll runs and final pay processing for terminations in accordance with applicable requirements
Produce payroll and labor reporting that helps finance and operations teams monitor workforce costs and payroll activity
Contribute to special payroll initiatives such as variance reviews and reporting or process enhancements

What we offer

medical, vision, dental, and life and disability insurance
enrollment in company 401(k) plan

Fulltime

New

Payroll Specialist

We are looking for a Payroll Specialist to manage end-to-end payroll operations ...

Location

United States , Fremont

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

At least 2 years of payroll experience, preferably in a construction or union environment
Hands-on experience processing full-cycle payroll for workforces ranging from approximately 100 to 500 employees
Knowledge of payroll practices for union, non-union, and non-exempt employees
Familiarity with federal, state, and local payroll tax reporting requirements and filing deadlines
Experience administering garnishments, levies, child support deductions, and related compliance processes
Understanding of workers’ compensation reporting, union reporting, annual tax forms, and audit support responsibilities
Strong accuracy, organizational skills, and ability to manage multiple payroll deadlines without compromising compliance

Job Responsibility

Administer weekly payroll for employees across multiple companies, including field and office staff, while confirming accuracy before final submission
Review imported time records, reconcile payroll totals, and prepare routine payroll reports to support timely processing
Manage federal, state, and local payroll tax activities, including filings, withholdings, reconciliations, and required periodic reporting
Verify tax setup details for new hires and maintain accurate employee payroll records within an integrated payroll environment
Process additional employee-related payments such as travel reimbursements, per diem, truck rent, and other approved expense items
Handle court-ordered deductions and involuntary withholdings, including garnishments, levies, and child support payments, in accordance with legal requirements
Complete workers’ compensation reporting, support annual true-up activities, prepare wage documentation for claims when needed, and coordinate premium payments
Prepare union payroll reporting, assist with union and insurance audits, and contribute documentation for annual financial statement reviews and census-related reporting
Record payroll-related general ledger entries and support special projects or ad hoc assignments requested by finance leadership

What we offer

Medical
Vision
Dental
Life and disability insurance
401(k) plan
Free online training (via Robert Half)

Fulltime

New

Disbursements Specialist

We are looking for a detail-oriented Disbursements Specialist to join our team i...

Location

United States , Westchester

Salary:

22.00 - 26.50 USD / Hour

Robert Half

Expiration Date

Until further notice

Requirements

2–5 years of experience in disbursements, accounts payable, finance operations, or another high-volume transactional setting
Advanced proficiency in Microsoft Excel, including Pivot Tables, VLOOKUP, formulas, and data analysis techniques
Strong analytical skills with the ability to interpret large datasets, identify trends, and resolve issues effectively
Demonstrated attention to detail and commitment to accuracy in financial processing and reporting activities
Ability to manage multiple deadlines and priorities in a fast-moving work environment
Clear written and verbal communication skills for working across internal teams and explaining financial information

Job Responsibility

Oversee daily payment and disbursement activity, ensuring transactions are completed accurately, on schedule, and in line with established controls
Examine high-volume financial records to verify data integrity, identify exceptions, and support timely resolution of discrepancies
Reconcile payment activity, payable balances, and related records to maintain accurate financial reporting and operational visibility
Partner with finance, accounting, and operations teams to investigate outstanding items and bring issues to closure efficiently
Produce remittance and transaction reports by consolidating information from multiple sources and confirming data accuracy before distribution
Use advanced Excel tools, including Pivot Tables, VLOOKUP, and formulas, to analyze large datasets and support reporting, validation, and trend review
Monitor aging items, payment exceptions, and reconciliation gaps, then provide clear updates and actionable insights to leadership
Contribute to process improvement efforts by identifying inefficiencies, recommending workflow enhancements, and supporting testing for new tools or system updates
Maintain organized documentation for procedures, controls, and operational changes, and assist with audit-related data requests when needed

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

Fulltime

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Payment Integrity Specialist

Job Description

Job Responsibility

Requirements

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