Senior Regulatory Compliance, Revenue Cycle Analyst

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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. • 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.

🎯 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. • 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.

🏖️ Benefits

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