Senior Regulatory Compliance, Revenue Cycle Analyst

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🕒 Junho 4

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Easterseals Northern California

SiteLinkedInTodas as Vagas

201 - 500 funcionários

Por mais de 90 anos, a Easterseals Northern California tem fornecido serviços para pessoas com deficiência e suas famílias para ajudá-las a alcançar seus objetivos. Estamos criando um mundo mais equitativo para que pessoas com deficiências intelectuais e de desenvolvimento possam escolher seu próprio caminho. Fazemos isso reinventando como o cuidado e o apoio podem ser melhor conectados para preencher lacunas nos serviços humanos ao longo da vida de um indivíduo.

Descrição

• Interpret and operationalize requirements across CMS, Medi-Cal (DHCS), DMHC, and other federal/state regulators. • Support compliance related to managed care contracts, delegated entities, and provider network operations. • Monitor and assess regulatory changes impacting health plans, reimbursement models, and care delivery. • Partner with legal, operations, and finance teams to ensure regulatory alignment in contracts and business practices. • Lead compliance oversight for billing, coding, documentation, and reimbursement practices. • Evaluate controls related to claims submission, denials management, and payment integrity. • Identify and mitigate risks related to overpayments, underpayments, and False Claims Act exposure. • Collaborate with Internal Audit and Enterprise Risk to align compliance monitoring with audit plans and enterprise risks. • Support compliance with HIPAA, HITECH, and applicable state privacy laws.

🎯 Requisitos

• 5+ years of experience in healthcare regulatory compliance, revenue cycle, or health plan operations. • Demonstrated expertise in billing, coding, reimbursement, and/or payment integrity. • Strong knowledge of government healthcare programs (e.g., Medicare, Medicaid/Medi-Cal). • Experience working in or with: Managed care organizations (MCOs). • Provider networks or delegated entities. • Healthcare services organizations. • Third-party vendors, business associates, or subcontracted service providers supporting healthcare operations. • Strong analytical and problem-solving skills. • Excellent communication and interpersonal skills. • Highly organized, self-motivated, and detail-oriented. • Ability to manage sensitive information with discretion and professionalism. • Passion for continuous learning and growth, with a dedication to social impact.

🏖️ Benefícios

• individual development programs • great team support • opportunities for career advancement