Senior Compliance Specialist

Job Summary

Supporting Payment Integrity and Payment Operations, the full-time Senior Compliance Specialist will serve as the primary compliance lead for regulatory requirements affecting claims, billing, reimbursement, and payment activities in a remote environment.

Key responsibilities

• Provide strategic guidance on regulatory and operational compliance matters related to Payment Integrity and Payment Operations
• Interpret and operationalize regulatory requirements, including the No Surprises Act and Fraud, Waste & Abuse laws
• Collaborate with cross-functional teams to identify and mitigate compliance risks associated with payment and claims functions

Required qualifications

• Bachelor's degree in Healthcare Administration, Finance, Business Administration, or a related field
• 5+ years of experience in healthcare compliance, payment integrity, or regulatory compliance
• Certified Professional Coder (CPC) credential or equivalent coding certification
• Knowledge of healthcare billing, coding, and reimbursement regulations
• Experience with Fraud, Waste & Abuse compliance frameworks and investigative processes