Manager, Regulatory Compliance

This is a fully remote position, open to applicants in United States.

📋 Description

• Develop and maintain a high-performing team of regulatory and reference data subject matter experts (SMEs) through proactive coaching, establishing clear expectations, and providing continuous feedback.

• Oversee the distribution of workload, prioritization, and timely delivery within the team to achieve regulatory milestones and fulfill Source product release commitments.

• Act as an escalation point for regulatory issues related to Source, assisting the team in navigating complex interpretations and resolutions.

• Collaborate with stakeholders from Product, Engineering, and Client Success to ensure that regulatory requirements are effectively understood and implemented in Source.

• Lead, manage, and enhance a team of regulatory compliance professionals specializing in claims pricing, reference data, and healthcare transparency mandates.

• Hold regular one-on-one meetings, performance evaluations, and discussions regarding career development.

• Foster a team culture built on accountability, intellectual rigor, collaboration, and a commitment to continuous improvement.

• Manage workload planning, capacity, and coverage to guarantee consistent adherence to regulatory timelines and data release schedules.

• Spearhead onboarding and skill enhancement for both new and current team members as Source’s regulatory landscape evolves.

• Supervise the team’s analysis, interpretation, and documentation of federal and state regulatory mandates affecting pricing, reference data, and editing.

• Ensure that regulatory outputs—including system requirement specifications and client-facing documents—are precise, timely, and meet quality benchmarks.

• Oversee the team’s assessment and response to regulatory changes pertinent to Source across commercial, Medicare Advantage, and Medicaid business lines.

• Manage the escalation and resolution of intricate regulatory issues impacting Source customers or product functionality.

• Collaborate with Source Product and Engineering teams to guarantee that regulatory requirements are integrated into roadmap planning and sprint execution.

• Work alongside Client Success and Implementation teams to assist health plan clients with inquiries related to Source regulatory content.

• Represent the team’s initiatives in cross-functional meetings, regulatory discussions, and client-facing interactions as necessary.

• Coordinate enterprise regulatory monitoring and cross-product impact assessments where Source data overlaps with other HealthEdge platforms.

⛳️ Requirements

• A Bachelor's degree or a comparable combination of education and experience.

• Over 8 years of experience in healthcare regulatory compliance, healthcare operations, managed care, or a related field.

• More than 5 years of progressive leadership experience, including managing teams of highly specialized professionals.

• Proven track record of building team capabilities, managing performance, and developing staff within a technical or compliance framework.

• Experience in or supporting a healthcare technology or managed care organization.

• Working knowledge of claims pricing, editing, and reference data concepts.

• Familiarity with Transparency in Coverage requirements, including MRF obligations, schema versioning, and standards for in-network/out-of-network file content.

• Ability to convert regulatory requirements into clear, actionable directives for team members and cross-functional colleagues.

• Excellent people management competencies, including coaching, feedback, performance management, and team development.

• Strong organizational and prioritization abilities; adept at managing multiple workstreams and release deadlines.

• Clear and effective written and verbal communication skills; capable of condensing complex regulatory material for diverse audiences.

🏝️ Benefits

• HealthEdge is an equal opportunity employer. We are dedicated to workforce diversity and actively encourage all qualified individuals, including but not limited to, racial and ethnic minorities, women, veterans, and persons with disabilities, to apply for employment with us.