Senior Regulatory Compliance and Revenue Cycle Analyst

Job not on LinkedIn

🔥 5 minutes ago

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Easterseals Northern California

WebsiteLinkedInAll Job Openings

201 - 500 employees

For more than 90 years, Easterseals Northern California has provided services to people with disabilities and their families to help them achieve their goals. We’re creating a more equitable world so people with intellectual and developmental disabilities can choose their path. We do this by reimagining how care and support can be better connected to fill gaps in human services across an individual’s lifespan.

📋 Description

• 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. • Support internal reviews and audits of revenue cycle processes, including root cause analysis and remediation. • Collaborate with Internal Audit and Enterprise Risk to align compliance monitoring with audit plans and enterprise risks. • Support and/or lead targeted compliance audits and assessments (e.g., coding, documentation, regulatory adherence).

🎯 Requirements

• 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 with the ability to interpret and apply legal and regulatory requirements in multi-jurisdictional regulatory environments. • Excellent communication and interpersonal skills, with the ability to work effectively with internal and external stakeholders; frequent proofreading and checking documents for accuracy. • Highly organized, self-motivated, and detail-oriented, demonstrating a proactive approach to compliance and privacy matters. • Ability to manage sensitive information with discretion and professionalism, always ensuring confidentiality and data security. • Passion for continuous learning and growth, with a dedication to social impact.

🏖️ Benefits

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