Senior Regulatory Compliance, Revenue Cycle Analyst

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

📋 Description

• Analyze and implement requirements from CMS, Medi-Cal (DHCS), DMHC, and other federal and state regulatory bodies.

• Assist with compliance matters concerning managed care agreements, delegated entities, and provider network operations.

• Track and evaluate regulatory modifications affecting health plans, reimbursement structures, and care delivery systems.

• Collaborate with legal, operational, and financial teams to ensure regulatory compliance in contracts and business operations.

• Oversee compliance for billing, coding, documentation, and reimbursement procedures.

• Assess controls related to claims submissions, denial management, and payment integrity.

• Identify and address risks associated with overpayments, underpayments, and exposure under the False Claims Act.

• Work with Internal Audit and Enterprise Risk to synchronize compliance monitoring with audit strategies and enterprise risk assessments.

• Ensure adherence to HIPAA, HITECH, and relevant state privacy regulations.

⛳️ Requirements

• A minimum of 5 years of experience in healthcare regulatory compliance, revenue cycle management, or health plan operations.

• Proven knowledge and experience in billing, coding, reimbursement, and/or payment integrity.

• Comprehensive understanding of government healthcare programs such as Medicare and Medicaid/Medi-Cal.

• Experience with Managed Care Organizations (MCOs).

• Familiarity with provider networks or delegated entities.

• Background in healthcare services organizations.

• Experience working with third-party vendors, business associates, or subcontracted service providers in the healthcare sector.

• Strong analytical and problem-solving abilities.

• Exceptional communication and interpersonal skills.

• Highly organized, self-driven, and detail-oriented.

• Capability to handle sensitive information with discretion and professionalism.

• Commitment to continuous learning and growth, with a focus on social impact.

🏝️ Benefits

• Individual development programs.

• Excellent team support.

• Opportunities for career advancement.