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compliance medicaid regulatory compliance📋 Description
- Ensure adherence to federal, state, local, and payer regulations; coordinate with Legal and Privacy.
- Develop, review, and update compliance policies and SOPs to reflect regulations.
- Conduct internal compliance audits and report findings to leadership.
- Support external audits; monitor medical records, billing and coding for quality.
- Perform clinical risk assessments and track corrective actions.
- Deliver tailored compliance trainings and regulatory updates.
🎯 Requirements
- 8+ years in healthcare compliance, clinical operations, or clinical quality & safety.
- Strong understanding of clinical ops and reimbursement/policy landscapes.
- Expertise in federal, state, payor regulations; Medicaid experience.
- Experience with multi-state virtual care regulations and clinical compliance.
- Audits/investigations management; cross-functional remediation.
- Clinical documentation and coding/billing compliance, high-risk workflows.
🎁 Benefits
- Flex PTO (3-5 wks/yr) + 11 paid holidays; parental leave.
- Competitive medical, dental, and vision plans with employer contributions.
- Company-paid short- and long-term disability, life, and AD&D insurance.
- Maven Clinic partnership for reproductive and family care.
- Employee Assistance Program (EAP) for mental health and support.
- 401(k) retirement plan.
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