Regulatory & Payer Operations Lead - Compliance & Audits

Coloplast; California; On-site; USD 27,000 - 39,000; Full time

Benefits offered by this job

Health insurance

401(k) plan with company match

Paid time off

Flexible work hours

Job summary

Coloplast in Ventura, CA seeks a Regulatory & Payer Operations Support Specialist to lead local regulatory and payer activities. You will coordinate surveys, manage Medicaid relations, verify insurance, and support prior authorizations and audit responses.

The role collaborates with clinical, operational, revenue cycle, and regulatory teams to ensure compliance and excellent service to patients and customers. A fulltime on-site position with comprehensive benefits is offered.

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.

Responsibilities

• Serve as the local point of contact for CMS, Medicaid, accreditation, and payer surveys.
• Maintain continuous survey readiness and regulatory compliance.
• 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 and payer policies within the assigned territory.
• Act as liaison between office, Medicaid agencies, and payer teams.
• Support insurance eligibility, authorizations, documentation, reimbursement, and claims.
• Coordinate collection of supporting documentation for audits and reviews.
• Support onboarding, training coordination, and personnel documentation management.

Skills

Microsoft Office

Documentation management

Communication skills

Organization

Problem-solving

Multitasking

Education

Associate or bachelor's degree in healthcare administration

Tools

CMS knowledge

Job description

Coloplast in Ventura, CA seeks a Regulatory & Payer Operations Support Specialist to lead local regulatory and payer activities. You will coordinate surveys, manage Medicaid relations, verify insurance, and support prior authorizations and audit responses.

The role collaborates with clinical, operational, revenue cycle, and regulatory teams to ensure compliance and excellent service to patients and customers. A fulltime on-site position with comprehensive benefits is offered.