Regulatory Compliance Analyst

🔥 5 hours ago

🇺🇸 United States – Remote

💵 $75k - $95k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🚔 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

• Monitor, interpret, and track CMS guidance such as Final Rules, HPMS memos, and Federal register communications impacting Medicare Advantage, Medicaid and other healthcare programs. • Communicate state and federal requirements to internal and external clients. • Prepare reports on regulatory communication and change management activities. • Oversee and maintain the organization regulatory distribution process. • Partner with internal business and product stakeholders to ensure compliance with CMS regulations and contract obligations. • Maintain regulatory tracking documentation and implementation timelines. • Track implementation activities and resolution of identified compliance risks. • Support the development of desk level procedures, presentations, and training materials.

🎯 Requirements

• Bachelor’s degree in healthcare administration, public health or related field. • Certification in healthcare compliance (CHC) preferred • Minimum of four (4) years of managed care, healthcare operations, or regulatory compliance. • Working knowledge of Medicare, Medicaid, and ACA health plan regulations along with related federal and state laws. • Strong interpersonal skills and the ability to collaborate with colleagues at all levels. • Excellent analytical, organizational, and communication skills. • Ability to prioritize and manage multiple cross-functional priorities. • Proficiency in Microsoft Excel, Word, PowerPoint, and tracking/reporting tools.

🏖️ Benefits

• Health insurance • Paid time off • Professional development opportunities