Job Summary:

This position is responsible for supporting the organization and clients in meeting Federal and State regulatory requirements and customer contractual compliance obligations. The role supports compliance initiatives by monitoring regulatory sources, analyzing, distributing, and tracking regulatory communications related to Medicare and Medicaid healthcare programs.  The role works cross-functionally with key stakeholders such as claims, enrollment, utilization management, risk adjustment, client success, product owners, vendors, and other areas to maintain adherence with CMS and state regulatory guidelines.

Key Responsibilities

Essential functions may vary depending on the specific focus of the role within the corporate compliance team

• 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

 Qualifications and Requirements:

• Bachelor’s degree in healthcare administration, public health or related field.
• Certification in healthcare compliance (CHC) preferred
• Minimum of four (4) years of healthcare experience.
• Experience in managed care, healthcare operations, or regulatory compliance preferred.
• 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.

Geographic Responsibility:  Remote, US

Type of Employment: Full-time, permanent 

FLSA Classification (USA Only): Exempt 

Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:  

• The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.  

• Work across multiple time zones in a hybrid or remote work environment. 

• Long periods of time sitting and/or standing in front of a computer using video technology. 

• May require travel dependent on company needs. 

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990.  Candidates may be required to go through a pre-employment criminal background check. 

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. 

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**The annual US base salary range for this position is $75,000 to $95,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.