Company
Healthcare
SeniorRegulatoryComplianceandRevenueCycleAnalyst
Neural analysis suggests this role is
optimal for Senior candidates.
“Senior Regulatory Compliance and Revenue Cycle Analyst. Skills: Regulatory compliance, Revenue cycle, Healthcare operations, Privacy. Interpret regulatory requirements. Operationalize regulatory requirements”
What You'll Achieve.
Enhance compliance; Enable operational efficiency
Industry & Context.
Analytical skills; Problem-solving skills; Root cause analysis
Criminal record clearance, Office Inspector General clearance, Attend required training
What They're Looking For.
Must Have
5+ years healthcare regulatory compliance, 5+ years revenue cycle, 5+ years health plan operations, Demonstrated expertise billing, Demonstrated expertise coding, Demonstrated expertise reimbursement, Demonstrated expertise payment integrity, Knowledge government healthcare programs, Experience managed care organizations, Experience provider networks, Experience delegated entities, Experience healthcare services organizations, Experience third-party vendors, Experience business associates, Experience subcontracted service providers, Analytical problem-solving skills, Interpret legal regulatory requirements, Apply legal regulatory requirements, Excellent communication skills, Excellent interpersonal skills, Highly organized, Self-motivated, Ability manage sensitive information, Ensure confidentiality, Ensure data security
Nice to Have
Deep familiarity CMS regulations, Deep familiarity DHCS, Deep familiarity HIPAA, Deep familiarity healthcare privacy, Working knowledge coding standards, Working knowledge FWA frameworks, Working knowledge False Claims Act, Experience supporting audits, Experience participating audits, Experience supporting regulatory reviews, Experience participating regulatory reviews, Experience managed care contracts, Experience delegated risk models, Exposure clinical operations, Exposure behavioral health services, Familiarity GRC platforms, Experience integrating compliance programs, Experience integrating audit programs, Experience integrating risk programs, Experience privacy frameworks GDPR, Experience privacy frameworks CCPA, Experience privacy frameworks HIPAA
What You'll Do.
Interpret regulatory requirements
Operationalize regulatory requirements
Support compliance managed care contracts
Support compliance delegated entities
Support compliance provider network operations
Monitor regulatory changes
Assess regulatory changes
Partner operations teams
Partner finance teams
Ensure regulatory alignment contracts
Ensure regulatory alignment business practices
Lead compliance oversight billing
Lead compliance oversight coding
Lead compliance oversight documentation
Lead compliance oversight reimbursement
Evaluate controls claims submission
Evaluate controls denials management
Evaluate controls payment integrity
Identify risks overpayments
Identify risks underpayments
Identify risks False Claims Act
Mitigate risks overpayments
Mitigate risks underpayments
Mitigate risks False Claims Act
Support internal reviews revenue cycle
Support audits revenue cycle
Support root cause analysis
Support remediation revenue cycle
Collaborate Internal Audit
Collaborate Enterprise Risk
Align compliance monitoring
Align enterprise risks
Support compliance audits
Lead compliance audits
Support compliance assessments
Lead compliance assessments
Contribute enterprise risk assessments
Assist developing controls
Assist developing KPIs
Assist developing monitoring frameworks
Support compliance with HIPAA
Support compliance with HITECH
Support compliance state privacy laws
Evaluate data use practices
Participate privacy incident response
Participate privacy investigations
Provide guidance clinicians
Provide guidance operational leaders
Conduct due diligence vendors
Support due diligence vendors
Assess compliance risks vendors
Assess compliance risks delegated entities
Drive process improvements
Enable operational efficiency
Translate regulatory requirements
Develop privacy guidance
Support privacy guidance
Develop privacy training materials
Support privacy training materials
How You'll Work.
Team & Collaboration
Cross-functional teams; Legal teams; Operations teams; Finance teams; Internal Audit; Enterprise Risk
Communication Scope
Verbal communication; Writing communication; Guidance; Training materials
Process & Methodology
Audit planning, Risk assessment, Process improvement
Full Job Description
This role sits at the intersection of regulatory privacy and compliance, health plan operations, and revenue cycle integrity. The Senior Regulatory Compliance & Revenue Cycle Analyst is responsible for advancing compliance across payer relationships, reimbursement practices, and healthcare regulatory frameworks, while supporting enterprise-wide GRC privacy and compliance initiatives. This individual will play a critical role in ensuring compliance with federal and state healthcare program requirements, strengthening billing and coding integrity, and embedding privacy and compliance into operational workflows. This is a high-impact, cross-functional role ideal for a compliance professional who understands how regulatory requirements translate into real-world healthcare operations, financial sustainability, and patient outcomes. **Essential Job Functions** **Regulatory Compliance (Health Plan & Government Programs)** * 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. **Revenue Cycle & Billing Compliance** * 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. * Support internal reviews and audits of revenue cycle processes, including root cause analysis and remediation. **Integrated GRC & Audit Support** * Collaborate with Internal Audit and Enterprise Risk to align compliance monitoring with audit plans and enterprise risks. * Support and/or lead ta
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