Regulatory & Payer Operations Lead - Flexible Hours

Coloplast; Tigard (OR); On-site; USD 27,000 - 39,000; Full time

Benefits offered by this job

Health insurance

Wellness programs

Paid parental leave

Job summary

Coloplast in Tigard, OR is seeking a Regulatory & Payer Operations Support Specialist to lead local regulatory, payer, and operational support. You will coordinate Medicaid/payer surveys, eligibility verification, prior authorizations, and audit responses while ensuring compliance across offices.

You will partner with clinical, regulatory, revenue cycle, and operations teams to deliver efficient patient and customer service and maintain readiness for surveys and audits.

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 continuous survey readiness and compliance with regulatory, 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 and interpret Medicaid regulations, payer policies, and reimbursement requirements within assigned territory.
• Act as a liaison between the local office, Medicaid agencies, managed care organizations, payer representatives and the Managed Care Access and Credentialing 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 new and existing patients.
• Submit, track, and follow up on prior authorization requests with government and commercial payers.
• Communicate authorization status and requirements to patients, providers, and internal stakeholders.
• Maintain accurate documentation of eligibility determinations, authorization approvals, denials, and appeals.
• Coordinate collection of supporting documentation for internal audits, payer audits, and regulatory reviews.
• Perform medical record chase activities with provider offices and clinicians 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 office resources.
• Promote ethical conduct and compliance with company policies.

Skills

Medicaid/Medicare experience

Insurance verification

Prior authorization processing

Audits & regulatory compliance

MS Office & documentation

Communication & organization

Multitasking in healthcare

Regulatory knowledge

Education

Associate or Bachelor's degree in Healthcare Administration

Job description

Coloplast in Tigard, OR is seeking a Regulatory & Payer Operations Support Specialist to lead local regulatory, payer, and operational support. You will coordinate Medicaid/payer surveys, eligibility verification, prior authorizations, and audit responses while ensuring compliance across offices.

You will partner with clinical, regulatory, revenue cycle, and operations teams to deliver efficient patient and customer service and maintain readiness for surveys and audits.