Regulatory & Payer Operations Lead

Comfort Medical, LLC; Florida; On-site; USD 27,000 - 39,000; Full time

Benefits offered by this job

Health insurance

Dental & Vision benefits

401(k) with company match

Paid time off

Flexible work hours

Job summary

Comfort Medical, LLC is seeking a Regulatory & Payer Operations Support Specialist to serve as the office-level lead for regulatory, payer, and operational activities in Florida. You will handle Medicaid coordination, survey readiness, and insurance verification, plus prior authorization support and audit response coordination to ensure compliance and efficient patient services.

The role partners with clinical, revenue cycle, and regulatory teams to maintain regulatory documentation, manage

Qualifications

• Minimum 2 years' experience with Medicaid, Medicare, payer operations, revenue cycle, healthcare reimbursement, or regulatory compliance.
• Experience with insurance verification, prior authorization processing, or payer communications.
• Experience supporting audits, surveys, compliance reviews, or regulatory inspections.
• Strong Microsoft Office skills and documentation management capabilities.
• Excellent communication, organization, and problem-solving skills.
• Ability to manage multiple priorities in a fast-paced healthcare environment.

Responsibilities

• Serve as the local point of contact for CMS, Medicaid, accreditation, and payer surveys.
• Maintain survey readiness and regulatory compliance with licensing, accreditation, and company requirements.
• Coordinate mock surveys, compliance audits, and readiness assessments; communicate findings and corrective actions.
• Maintain regulatory documentation and support office leadership in compliance monitoring.
• Monitor Medicaid regulations, payer policies, and reimbursement requirements within the assigned territory.
• Act as liaison between the local office, Medicaid agencies, managed care organizations, payer representatives and the teams.
• Work cross-functionally to support issue resolution related to eligibility, authorizations, documentation, reimbursement, and claims.
• Provide updates regarding payer requirements and regulatory changes.
• Conduct insurance eligibility and benefit verification for patients.
• Submit, track, and follow up on prior authorization requests with payers.
• Communicate authorization status and requirements to patients, providers, and internal stakeholders.
• Maintain documentation of eligibility determinations, approvals, denials, and appeals.
• Coordinate collection of supporting documentation for audits and regulatory reviews.
• Perform medical record chase activities to obtain required records.
• Ensure completeness and accuracy of records prior to submission.
• Maintain audit trackers and monitor response deadlines.
• Coordinate administrative activities supporting daily office operations and compliance.
• Support onboarding, training coordination, and personnel documentation management.
• Maintain office records, logs, reports, equipment, and resources.
• Promote ethical conduct and compliance with company policies and applicable regulations.
• Perform other duties as assigned.

Skills

Regulatory compliance

Insurance verification

Prior authorization processing

Audit support

Documentation management

Microsoft Office

Communication skills

Education

Associate or bachelor's degree

Healthcare administration related field

Tools

Microsoft Office Suite

Job description

Comfort Medical, LLC is seeking a Regulatory & Payer Operations Support Specialist to serve as the office-level lead for regulatory, payer, and operational activities in Florida. You will handle Medicaid coordination, survey readiness, and insurance verification, plus prior authorization support and audit response coordination to ensure compliance and efficient patient services.

The role partners with clinical, revenue cycle, and regulatory teams to maintain regulatory documentation, manage