Regulatory Compliance Principal

HealthEdge; United States; Remote; USD 100,000 - 125,000; Full time

Job summary

An established industry player is seeking a Regulatory Compliance Principal to lead compliance efforts in healthcare. This role involves leveraging innovative technology to ensure that software products align with federal and state regulations. You will be the go-to expert, guiding both internal teams and external stakeholders through the complexities of healthcare compliance. Your insights will help shape product development and enhance customer success. If you are passionate about regulatory compliance and eager to make a significant impact in the healthcare sector, this is the perfect opportunity for you.

Qualifications

• 7+ years of experience in healthcare compliance focusing on Medicare, Medicaid, and NCQA.
• Ability to interpret complex regulations into actionable business solutions.

Responsibilities

• Monitor and analyze healthcare regulatory requirements for compliance.
• Collaborate with product teams to align software solutions with regulations.

Skills

Healthcare Compliance

Regulatory Analysis

Communication Skills

Analytical Skills

Interpersonal Skills

Education

Bachelor’s degree in healthcare-related field

Advanced degree (e.g., law, clinical)

Job description

Overview

Position Overview:

The Regulatory Compliance Principal will be the subject matter expert in healthcare regulatory compliance with a passion for leveraging innovative technology to address critical needs in healthcare. This individual will play a pivotal role in ensuring that our suite payer-focused software products support our customers in achieving and maintaining compliance with federal, state, and accreditation body requirements. The Director, Regulatory Compliance will serve as a strategic advisor to internal and external stakeholders, driving regulatory adherence and aligning our products with the ever-evolving healthcare landscape.

Your Impact:

Regulatory Expertise:

• Proactively monitor, interpret, and analyze NCQA, URAC, CMS, and state regulatory requirements and updates, providing actionable insights for our products and customers.
• Partner with Legal and Compliance teams to identify and document clinical and payer-specific regulations relevant to our product portfolio.
• Serve as the subject matter expert and advisor on healthcare regulations, ensuring stakeholders understand the implications for our products and our customers’ operations.
• Research trends and developments in governmental regulations to inform the product roadmap and strategic planning.

Product Alignment:

• Collaborate with Product and Marketing teams to position our software solutions as tools to enhance compliance and drive customer success.
• Identify areas of non-compliance within applications, services, and processes, developing action plans to mitigate risks.
• Develop and maintain a compliance scorecard to monitor adherence across the product portfolio, driving continuous improvement.
• Support product development by defining business cases and requirements for new features or enhancements that align with regulatory standards.

Customer and Stakeholder Engagement:

• Communicate regulatory changes clearly and effectively to internal and external audiences through briefs, user groups, blogs, and 1:1 customer sessions.
• Partner with customers to address compliance-related inquiries and provide guidance on best practices for implementing regulatory requirements.
• Deliver internal training sessions on regulatory updates and compliance requirements to enhance organizational knowledge and alignment.

Audit Readiness and Reporting:

• Lead regulatory survey readiness planning for accreditations and certifications.
• Ensure workflows, policies, and procedures are in place to meet relevant regulatory and accreditation requirements.
• Assist Customer Support in triaging and resolving compliance issues reported by customers.

What You Bring:

• Bachelor’s degree in a healthcare-related field required; advanced degree (e.g., law, clinical) preferred.
• 7+ years of experience in healthcare compliance, with a focus on Medicare, Medicaid, NCQA, CMS, URAC, and state regulatory requirements.
• Extensive experience in the payer space, with knowledge of health plan operations and their digital transformation needs.
• Demonstrated experience working with regulatory requirements in a software product development environment.
• Advanced understanding of healthcare regulations, including HEDIS, CMS reporting, and audit requirements.
• Ability to interpret complex regulations and translate them into actionable business solutions.
• Strong interpersonal, communication, organizational, and coordination skills.
• Analytical and storytelling capabilities to educate and align internal and external audiences on compliance matters.
• Proven ability to work independently, collaboratively, and as a team leader.

Bonus Points:

• Familiarity with HEDIS data and analytics.
• Experience delivering training to small groups.

HealthEdge commits to building an environment and culture that supports the diverse representation of our teams. We aspire to have an inclusive workplace. We aspire to be a place where all employees have the opportunity to belong, make an impact and deliver excellent software and services to our customers.

Geographic Responsibility: While HealthEdge is located in Burlington, MA you may live anywhere in the US.

Type of Employment: Full-time, permanent

Work Environment:

• 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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