Regulatory Compliance Analyst

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

📋 Description

• Facilitate and assist with both internal and external audits, which include CMS Program Audits, state audits, delegation oversight audits, and audits driven by clients.

• Oversee, analyze, and monitor CMS guidance, Final Rules, HPMS memos, audit protocols, and communications from the Federal Register.

• Create, draft, and oversee Corrective Action Plans in response to audit results, self-identified concerns, or regulatory notifications.

• Manage the tracking of CAP milestones, deliverables, and deadlines until submission and final resolution.

• Relay audit results, CAP progress, and regulatory obligations to relevant stakeholders.

• Assemble materials for audit preparedness, gather universe data, and compile necessary documentation.

• Sustain audit and CAP tracking processes alongside centralized logs.

• Collaborate with business and product stakeholders to confirm corrective measures and ongoing compliance.

• Preserve documentation for audits and CAPs, including evidence files and timelines for implementation.

• Monitor compliance risk resolution and escalate any unresolved or high-risk issues.

• Assist in the development of desk-level procedures, audit playbooks, presentations, and training resources.

⛳️ Requirements

• Bachelor’s degree in healthcare administration, public health, or a related discipline.

• At least four (4) years of experience in managed care, healthcare operations, or regulatory compliance.

• Solid understanding of regulations related to Medicare, Medicaid, and ACA health plans, as well as associated federal and state laws.

• Proven experience in developing and managing Corrective Action Plans, including conducting root cause analyses and tracking remediation efforts.

• Excellent interpersonal, analytical, organizational, and communication capabilities.

• High level of attention to detail.

• Competence in prioritizing and managing multiple cross-functional audit and CAP tasks concurrently.

• Proficient in Microsoft Excel, Word, PowerPoint, and tools for audit/CAP tracking or case management.

• Certification in healthcare compliance (CHC) is preferred.

• Experience in supporting or leading CMS Program Audits, state audits, or client audits is preferred.

• Ability to operate across various time zones in a hybrid or remote work setting.

• Candidates may need to undergo a pre-employment criminal background check.

🏝️ Benefits

• Remote work arrangement.

• Full-time, permanent position.

• Classification as exempt under FLSA.

• Travel may be required based on company needs.

• Reasonable accommodations available for individuals with disabilities.

• Commitment to equal opportunity and workforce diversity.