Regulatory Compliance Specialist

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

📋 Description

• Act as the main coordinator and project leader for external audits, regulatory inquiries, investigative efforts, and information requests from MFCUs, UPICs, DOJ, OIG, Attorneys General, state Medicaid programs, MCO clients, and other authorized oversight bodies.

• Receive and evaluate each request, creating documented workplans and response timelines.

• Oversee multiple simultaneous requests from initiation to final submission, maintaining trackers, status reports, action items, dependencies, deliverables, and deadlines.

• Collaborate with cross-functional teams to gather necessary operational records and data.

• Assess retrieved records and datasets for completeness, accuracy, consistency, relevance, and responsiveness; identify and address gaps, discrepancies, duplicates, and exceptions.

• Prepare and organize response packages, which include data files, supporting records, exhibits, indexes, summaries, chronologies, and draft written responses.

• Collaborate with Legal and Compliance on legal interpretation, privilege, regulatory strategy, escalation, and review of responses.

• Raise any potential compliance, fraud, abuse, or significant operational issues.

• Communicate with internal stakeholders and authorized external requestors to clarify requirements and manage submission logistics and deadlines.

• Maintain secure repositories, workpapers, correspondence, source data, final packages, and submission records in compliance with retention, privacy, security, and document control regulations.

• Utilize Microsoft Excel and other data tools to analyze datasets, detect trends or anomalies, reconcile information, and create supporting schedules.

• Assist with follow-up requests, supplemental documentation, interviews, and additional inquiries while ensuring version control.

• Identify opportunities for process improvements related to investigations, audits, information requests, tracking, reporting, documentation, and turnaround times.

• Keep up-to-date with healthcare, Medicaid, privacy, records management, audit, and regulatory requirements.

• Perform additional duties as assigned.

⛳️ Requirements

• A Bachelor's degree in business, healthcare administration, health information management, compliance, accounting, criminal justice, public administration, or a related field is preferred; equivalent relevant experience may be considered.

• A minimum of three (3) years of progressively responsible experience in healthcare audit, regulatory response, compliance, investigations, project management, healthcare operations, or a related field is required.

• Direct experience in responding to government or regulatory requests from entities such as MFCU, UPIC, DOJ, OIG, Attorneys General, state Medicaid agencies, or MCOs is strongly preferred.

• Experience managing audits or information requests involving claims data, trip/service records, billing or payment data, provider records, or other healthcare documentation is strongly preferred.

• Familiarity with Medicaid, NEMT/mobility, personal care services, home care, managed care, or another regulated healthcare environment is preferred.

• Proficient in using Excel for data analysis, reconciliation, filtering, pivot tables, lookups, and preparation of supporting schedules is preferred.

• Project management, audit, compliance, healthcare data, or fraud/waste/abuse training or certification is a plus.

• Proven experience managing external audits, regulatory inquiries, investigations, information requests, or similar compliance-driven projects in a healthcare or other highly regulated environment.

• Strong project management skills, including the capacity to create workplans, handle competing priorities, track dependencies, drive action items, and meet strict regulatory or contractual deadlines.

• Working knowledge of Medicaid programs, healthcare claims, healthcare operations, fraud, waste, and abuse concepts, and regulatory oversight processes; experience with NEMT, mobility, personal care, home care, or related services is strongly preferred.

• Ability to interpret detailed requests, break complex requirements into actionable tasks, and identify the records, data, and subject matter expertise necessary for a comprehensive response.

• Strong analytical skills, capable of reviewing, reconciling, and validating claims, service, trip, billing, payment, provider, and other operational data across various systems and sources.

• Advanced proficiency in Microsoft Excel and Microsoft Office applications; experience with large datasets, reporting tools, or data visualization platforms is preferred.

• Excellent written communication skills, including the ability to craft clear, concise, fact-based summaries and responses for both internal and external audiences.

• Exceptional attention to detail and sound judgment when handling sensitive, confidential, regulated, and potentially investigative information.

• Ability to work autonomously, exercise appropriate escalation judgment, and collaborate effectively with Legal, Compliance, Operations, Claims, Finance, IT, Provider Management, and other cross-functional teams.

• Capacity to maintain organized workpapers, version control, document indexes, supporting schedules, and audit trails sufficient to demonstrate how a response was developed and supported.

• Professional communication skills and the ability to manage high-priority requests in a fast-paced environment with shifting requirements and tight deadlines.

🏝️ Benefits

• Medical, Dental, and Vision insurance

• Employer Paid Basic Life Insurance and AD&D

• Voluntary Life Insurance (Employee/Spouse/Child)

• Health Care and Dependent Care Flexible Spending Accounts

• Pre-Tax and Post-Tax Commuter and Parking Benefits

• 401(k) Retirement Savings Plan with Company Match

• Paid Time Off

• Paid Parental Leave

• Short-Term and Long-Term Disability

• Tuition Reimbursement

• Employee Discounts (retail, hotel, food, restaurants, car rental, and much more!)