Manager, Regulatory Compliance

HealthEdge; United States; Remote; USD 148.000 - 156.000; Vollzeit

Zusammenfassung

HealthEdge is seeking a Manager, Regulatory Compliance to lead a team of regulatory professionals supporting HealthEdge Source™, including reference data and pricing transparency capabilities.

The role focuses on interpreting federal and state regulations, aligning pricing and product changes for commercial, Medicare, and Medicaid lines of business, and coaching a high-performing team to deliver accurate regulatory outputs on time.

Qualifikationen

• Bachelor's degree or equivalent in a related field.
• 8+ years of experience in healthcare regulatory compliance or related field.
• 5+ years of progressive people leadership experience.
• Experience with healthcare SaaS or managed care preferred.

Aufgaben

• Lead and develop a team of regulatory professionals across filing, pricing, and data governance.
• Oversee regulatory monitoring, interpretation, and documentation for CMS, state programs.
• Partner with Product, Engineering, and Client Success to operationalize regulatory requirements.
• Escalation management and cross-functional communication for regulatory changes.

Kenntnisse

Regulatory compliance

People leadership

Healthcare data

Stakeholder collaboration

Ausbildung

Bachelor's degree

Tools

Claims pricing

Reference data

Jobbeschreibung

Overview

Overview:

HealthEdge is seeking a Manager, Regulatory Compliance to lead a team of regulatory professionals supporting HealthEdge Source™,HealthEdge’sreference data and pricing transparency platform.TheManager, Regulatory Compliancewilllead a team of regulatory professionalsresponsible for monitoring, interpreting, and operationalizing federal and state regulatory requirementsto align our products with regulatory changesimpactingcommercial, Medicare, and Medicaid lines of business.TheManager will coach, develop, andleada team of claims pricing and editing subject matter experts, ensuring high-quality regulatory outputs,strong teamengagement, and operational excellence.

The ideal candidate is a proven people manager who brings healthcare regulatory or reference data knowledge sufficient to guide the team’s work – someone who leads through others, builds capability, and creates accountability structures that allow the team to deliver consistently against a complex and evolving regulatory landscape.

Your Impact

As the Manager, Regulatory Compliance for HealthEdge Source™, you will:

• Build and sustain a high-performing team of regulatory and reference data SMEs through active coaching, clear expectations, and ongoing feedback.

• Manage workload distribution, prioritization, and delivery across the team to meet regulatory milestones and Source product release commitments.

• Serve asanescalation point for Source-related regulatory issues, guiding the team through complex interpretation and resolution.

• Partner with Product, Engineering, and Client Success stakeholders to ensure regulatory requirementsare clearly understoodand operationalized in Source.

What you will do:

People Leadership & Team Management

• Lead, supervise, and develop a team of regulatory compliance professionals withexpertiseinclaimspricing, reference data, and healthcare transparency requirements.

• Conduct regular one-on-ones, performance reviews, and career development conversations.

• Build ateamculture grounded in accountability, intellectual rigor, collaboration, and continuous improvement.

• Manage workload planning, capacity, and coverage to ensure consistent delivery against regulatory timelines and data release cycles.

• Drive onboarding and skill development for new and existing team members as Source’s regulatory scope evolves.

Source Regulatory Operations

• Oversee the team’s monitoring, interpretation, and documentation of federal and state regulatory requirementsimpactingpricing, referencedataand editing.

• Ensure regulatory deliverables-system requirement specifications, and client-facing materials – areaccurate,timely, and meet quality standards.

• Manage the team’s review and disposition of regulatory changes relevant to Source across commercial, Medicare Advantage, and Medicaid lines of business.

• Oversee escalation management and resolution of complex regulatory issues affecting Source customers or product functionality.

Cross-Functional Partnership

• Partner with Source Product and Engineering to ensure regulatory requirementsare incorporatedinto roadmap planning and sprint execution.

• Collaborate with Client Success and Implementation teams to support health plan client inquiries related to Source regulatorycontent.

• Represent the team’s work in cross-functional meetings, regulatory forums, and client-facing engagements as needed.

• Coordinate on enterprise regulatory monitoring and cross-product impact assessments where Source data intersects with other HealthEdge platforms.

What you bring:

Education & Experience

• Bachelor's degree or equivalent combination of education and experience.

• 8+ years of experience in healthcare regulatory compliance, healthcare operations, managed care, ora relatedfield.

• 5+ years of progressivepeopleleadership experience, including leading teams of highly specialized professionals.

• Demonstratedsuccessbuilding team capability, managing performance, and developing staff in a technical or compliance environment.

• Experience working within or in support of a healthcare technology or managed care organization.

Knowledge, Skills & Abilities

• Working knowledgeofclaimspricing,editingand reference data concepts

• Familiarity with Transparency in Coverage requirements, including MRF obligations, schema versioning, and in-network/out-of-network file content standards.

• Ability to translate regulatory requirements into clear, actionable guidance for team members and cross-functional partners.

• Exceptionalpeoplemanagement skills: coaching, feedback, performance management, and team building.

• Strong organizational and prioritization skills; comfortable managing multiple workstreams and release deadlines.

• Clear written and verbal communication; able to summarize complex regulatory content for varied audiences.

Preferred Qualifications

• Experience supporting healthcare SaaS products or healthcare technology platforms.

• Familiarity with HealthEdge Source™ or comparableclaims pricing, editing,reference data and pricing transparency platforms.

• Knowledge of CMS regulations, NCQA accreditation standards, interoperability requirements, HL7 FHIR, TEFCA, HIPAA, and related healthcare compliance frameworks.

• Experience supporting core administration platforms, care management solutions, or digital health technologies.

• Familiarity with Agile product development methodologies and regulatory-driven release management.

• Experience leading organizational transformation, functional redesign, or large-scale compliance initiatives.

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 employeeis occasionally required tomove 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 periodsof 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 skillsrequired. HealthEdge reserves the right to modify, add, or remove duties and to assign otherdutiesas 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 maybe requiredto 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.

#LI-Remote

**The annual US base salary range for this positionis $148,000 to $156,000.