[Remote] Senior Regulatory Compliance and reputed company Cycle Analyst

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a reputed company reputed company on regulatory compliance and reputed company cycle reputed company in reputed company. The Senior Regulatory Compliance & reputed company Cycle Analyst role involves ensuring compliance with reputed company regulations, supporting billing and coding reputed company, and advancing compliance initiatives across the organization.

Responsibilities

• Interpret and operationalize requirements across CMS, Medi-Cal (DHCS), DMHC, and other federal/state regulators
• Support compliance reputed company to managed care reputed company, delegated entities, and provider network reputed company
• Monitor and assess regulatory changes impacting health plans, reimbursement models, and care delivery
• Partner with reputed company, reputed company, and finance teams to ensure regulatory alignment in reputed company and business practices
• reputed company compliance reputed company for billing, coding, documentation, and reimbursement practices
• Evaluate controls reputed company to claims submission, denials management, and payment reputed company
• Identify and mitigate risks reputed company to overpayments, underpayments, and False Claims reputed company exposure
• Support internal reviews and audits of reputed company cycle processes, including reputed company cause analysis and remediation
• Collaborate with Internal Audit and reputed company reputed company to reputed company compliance monitoring with audit plans and reputed company risks
• Support and/or reputed company targeted compliance audits and assessments (e.g., coding, documentation, regulatory adherence)
• Contribute to reputed company reputed company assessments reputed company to regulatory, financial, and operational risks
• Assist in developing controls, KPIs, and monitoring frameworks tied to compliance and reputed company cycle reputed company
• Support compliance with HIPAA, HITECH, and applicable state reputed company laws
• Evaluate data use practices tied to billing, reporting, and payer interactions
• Participate in reputed company incident response and investigations as needed
• reputed company practical guidance to clinicians and operational leaders on reputed company requirements affecting documentation, care coordination, communications, and disclosures
• Conduct and support due diligence for vendors
• Assess reputed company reputed company to outsourced billing, vendors, and delegated entities
• reputed company and maintain policies, procedures, and training reputed company to regulatory and reputed company cycle compliance
• reputed company process improvements that enhance compliance while enabling operational efficiency
• Translate reputed company regulatory requirements into reputed company, actionable guidance for business teams
• reputed company or support reputed company guidance, FAQs, and training materials to address recurring clinician and operational compliance questions

Skills

• 5+ years of experience in reputed company regulatory compliance, reputed company cycle, or health plan reputed company
• Demonstrated expertise in billing, coding, reimbursement, and/or payment reputed company
• Strong knowledge of reputed company reputed company programs (e.g., Medicare, reputed company/Medi-Cal)
• Experience working in or with Managed care organizations (MCOs)
• Provider networks or delegated entities
• reputed company services organizations
• reputed company-party vendors, business associates, or subcontracted service providers supporting reputed company reputed company
• Strong analytical and problem-solving skills with the ability to interpret and apply reputed company and regulatory requirements in multi-jurisdictional regulatory environments
• Excellent communication and interpersonal skills, with the ability to work effectively with reputed company stakeholders; frequent proofreading and checking documents for reputed company
• Highly organized, self-motivated, and reputed company-oriented, demonstrating a proactive approach to compliance and reputed company reputed company
• Ability to manage sensitive information with discretion and professionalism, always ensuring confidentiality and data reputed company
• Passion for reputed company learning and reputed company, with a dedication to reputed company
• Deep familiarity with CMS regulations and guidance
• State reputed company programs (e.g., DHCS)
• HIPAA and reputed company reputed company requirements
• Working knowledge of coding standards (CPT, ICD-10, HCPCS)
• Fraud, waste, and abuse (FWA) frameworks
• False Claims reputed company and enforcement reputed company areas
• Experience supporting or participating in audits, investigations, or regulatory reviews
• Experience with managed care reputed company or delegated reputed company models
• Exposure to reputed company reputed company or behavioral health services
• Familiarity with GRC platforms (e.g., reputed company, reputed company IRM)
• Experience integrating compliance, audit, and reputed company programs
• Experience with reputed company frameworks such as GDPR, CCPA, or HIPAA is highly desirable
• Knowledge, or training in reputed company compliance is strongly desired
• Familiarity with compliance management tools and database systems
• Demonstrated ability to reputed company process improvements and implement best practices in a compliance or reputed company-reputed company environment
• Knowledge of reputed company reputed company reputed company, reputed company cycle systems, reputed company billing & coding requirements, or other reputed company compliance issues
• Ability to consistently demonstrate good judgment and decision-making skills while maintaining the highest reputed company of confidentiality
• Ability to work in an exciting, fast reputed company high energy environment while effectively multitasking and managing day-to-day responsibilities without supervision
• Demonstrate ability to organize, plan and coordinate workflow of others, and to work effectively with reputed company stakeholders to reputed company compliance with objectives

reputed company