Manager, Regulatory Compliance

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $148k - $156k / year

⏰ Full Time

🟠 Senior

🔴 Lead

🚔 Compliance

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HealthEdge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2005

⚕️ Healthcare Insurance

☁️ SaaS

💳 Fintech

Healthcare Insurance • SaaS • Fintech

HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.

📋 Description

• Build and sustain a high-performing team of regulatory and reference data SMEs through active coaching, clear expectations, and ongoing feedback. • Manage workload distribution, prioritization, and delivery across the team to meet regulatory milestones and Source product release commitments. • Serve as an escalation point for Source-related regulatory issues, guiding the team through complex interpretation and resolution. • Partner with Product, Engineering, and Client Success stakeholders to ensure regulatory requirements are clearly understood and operationalized in Source. • Lead, supervise, and develop a team of regulatory compliance professionals with expertise in claims pricing, reference data, and healthcare transparency requirements. • Conduct regular one-on-ones, performance reviews, and career development conversations. • Build a team culture grounded in accountability, intellectual rigor, collaboration, and continuous improvement. • Manage workload planning, capacity, and coverage to ensure consistent delivery against regulatory timelines and data release cycles. • Drive onboarding and skill development for new and existing team members as Source’s regulatory scope evolves. • Oversee the team’s monitoring, interpretation, and documentation of federal and state regulatory requirements impacting pricing, reference data and editing. • Ensure regulatory deliverables - system requirement specifications, and client-facing materials – are accurate , timely , and meet quality standards. • Manage the team’s review and disposition of regulatory changes relevant to Source across commercial, Medicare Advantage, and Medicaid lines of business. • Oversee escalation management and resolution of complex regulatory issues affecting Source customers or product functionality. • Partner with Source Product and Engineering to ensure regulatory requirements are incorporated into roadmap planning and sprint execution. • Collaborate with Client Success and Implementation teams to support health plan client inquiries related to Source regulatory content. • Represent the team’s work in cross-functional meetings, regulatory forums, and client-facing engagements as needed. • Coordinate on enterprise regulatory monitoring and cross-product impact assessments where Source data intersects with other HealthEdge platforms.

🎯 Requirements

• Bachelor's degree or equivalent combination of education and experience. • 8 + years of experience in healthcare regulatory compliance, healthcare operations, managed care, or a related field. • 5+ years of progressive people leadership experience, including leading teams of highly specialized professionals. • Demonstrated success building team capability, managing performance, and developing staff in a technical or compliance environment. • Experience working within or in support of a healthcare technology or managed care organization. • Working knowledge of claims pricing , editing and reference data concepts. • Familiarity with Transparency in Coverage requirements, including MRF obligations, schema versioning, and in-network/out-of-network file content standards. • Ability to translate regulatory requirements into clear, actionable guidance for team members and cross-functional partners. • Exceptional people management skills: coaching, feedback, performance management, and team building. • Strong organizational and prioritization skills; comfortable managing multiple workstreams and release deadlines. • Clear written and verbal communication; able to summarize complex regulatory content for varied audiences.

🏖️ Benefits

• HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities.