Senior Regulatory Compliance, Revenue Cycle Analyst

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Easterseals Northern California

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201 - 500 employés

Depuis plus de 90 ans, Easterseals Northern California fournit des services aux personnes en situation de handicap et à leurs familles pour les aider à atteindre leurs objectifs. Nous œuvrons pour un monde plus équitable afin que les personnes avec des déficiences intellectuelles et développementales puissent choisir leur voie. Nous y parvenons en réimaginant la manière dont les soins et le soutien peuvent être mieux connectés pour combler les lacunes dans les services humains tout au long de la vie d'une personne.

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.

🎯 Exigences

• 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.

🏖️ Avantages

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