Regulatory Compliance Specialist

Job not on LinkedIn

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $50k - $65k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🚔 Compliance

🦅 H1B Visa Sponsor

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Modivcare

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2017

🏥 Healthcare

⚕️ Healthcare Insurance

🚗 Transport

💰 $525M Post-IPO Debt on 2024-07

Healthcare • Healthcare Insurance • Transport

Modivcare is a company that focuses on simplifying the experience of living with complex healthcare needs by providing a comprehensive suite of supportive care solutions. They specialize in non-emergency medical transportation, personal care, and virtual & remote patient monitoring. Modivcare works closely with Medicaid Plans, State Agencies, Medicare Advantage, SNP Plans, health systems, healthcare professionals, and transportation providers, ensuring that members receive necessary health services. Through innovative technology and data-driven strategies, they address social determinants of health by offering services like quality transportation, chronic care management, meal delivery, and in-home assistance, aimed at optimizing patients' health outcomes and improving their overall experience.

📋 Description

• Serve as the primary coordinator and project lead for external audit, regulatory, investigative, and information requests from MFCUs, UPICs, DOJ, OIG, Attorneys General, state Medicaid programs, MCO clients, and other authorized oversight entities. • Intake and assess each request, establishing documented workplans and response timelines. • Manage multiple concurrent requests from initiation through final submission, maintaining trackers, status reports, action items, dependencies, deliverables, and deadlines. • Coordinate cross-functional teams to obtain responsive operational records and data. • Review retrieved records and datasets for completeness, accuracy, consistency, relevance, and responsiveness; identify and resolve gaps, discrepancies, duplicates, and exceptions. • Prepare and organize response packages, including data files, supporting records, exhibits, indexes, summaries, chronologies, and draft written responses. • Coordinate with Legal and Compliance on legal interpretation, privilege, regulatory strategy, escalation, and response review. • Escalate potential compliance, fraud, abuse, or material operational issues. • Communicate with internal stakeholders and authorized external requestors to clarify needs and manage submission logistics and deadlines. • Maintain secure repositories, workpapers, correspondence, source data, final packages, and submission records in accordance with retention, privacy, security, and document-control requirements. • Use Microsoft Excel and other data tools to analyze datasets, identify trends or anomalies, reconcile information, and develop supporting schedules. • Support follow-up requests, supplemental documentation, interviews, and additional questions while maintaining version control. • Identify process improvements for investigations, audits, information requests, tracking, reporting, documentation, and turnaround time. • Maintain current knowledge of healthcare, Medicaid, privacy, records management, audit, and regulatory requirements. • Perform other duties as assigned.

🎯 Requirements

• Bachelor's degree in business, healthcare administration, health information management, compliance, accounting, criminal justice, public administration, or a related field preferred; equivalent relevant experience may be considered. • Three (3) plus years of progressively responsible experience in healthcare audit, regulatory response, compliance, investigations, project management, healthcare operations, or a related field required. • Direct experience responding to government or regulatory requests from entities such as MFCU, UPIC, DOJ, OIG, Attorneys General, state Medicaid agencies, or MCOs strongly preferred. • Experience managing audits or information requests involving claims data, trip/service records, billing or payment data, provider records, or other healthcare documentation strongly preferred. • Experience in Medicaid, NEMT/mobility, personal care services, home care, managed care, or another regulated healthcare environment preferred. • Experience using Excel for data analysis, reconciliation, filtering, pivot tables, lookups, and preparation of supporting schedules preferred. • Project management, audit, compliance, healthcare data, or fraud/waste/abuse training or certification is a plus. • Demonstrated experience managing external audits, regulatory inquiries, investigations, information requests, or similar compliance-driven projects in a healthcare or other highly regulated environment. • Strong project management skills, including the ability to establish workplans, manage competing priorities, track dependencies, drive action items, and meet firm regulatory or contractual deadlines. • Working knowledge of Medicaid programs, healthcare claims, healthcare operations, fraud, waste and abuse concepts, and regulatory oversight processes; experience with NEMT, mobility, personal care, home care, or related services strongly preferred. • Ability to interpret detailed requests, break complex requirements into actionable tasks, and determine the records, data, and subject matter expertise needed to support a complete response. • Strong analytical skills with the ability to review, reconcile, and validate claims, service, trip, billing, payment, provider, and other operational data across multiple systems and sources. • Advanced proficiency with Microsoft Excel and Microsoft Office applications; experience working with large datasets, reporting tools, or data visualization platforms preferred. • Excellent written communication skills, including the ability to draft clear, concise, fact-based summaries and responses for internal and external audiences. • Strong attention to detail and sound judgment when handling sensitive, confidential, regulated, and potentially investigative information. • Ability to work independently, exercise appropriate escalation judgment, and collaborate effectively with Legal, Compliance, Operations, Claims, Finance, IT, Provider Management, and other cross-functional teams. • Ability to maintain organized workpapers, version control, document indexes, supporting schedules, and audit trails sufficient to demonstrate how a response was developed and supported. • Professional communication skills and the ability to manage high-priority requests in a fast-paced environment with changing requirements and tight deadlines.

🏖️ Benefits

• Medical, Dental, and Vision insurance • Employer Paid Basic Life Insurance and AD&D • Voluntary Life Insurance (Employee/Spouse/Child) • Health Care and Dependent Care Flexible Spending Accounts • Pre-Tax and Post-Tax Commuter and Parking Benefits • 401(k) Retirement Savings Plan with Company Match • Paid Time Off • Paid Parental Leave • Short-Term and Long-Term Disability • Tuition Reimbursement • Employee Discounts (retail, hotel, food, restaurants, car rental and much more!)