Regulatory & Payer Operations Lead (Medicaid)

Comfort Medical, LLC; Ventura (CA); On-site; USD 30,000 - 36,000; Full time

Benefits offered by this job

Health insurance

401(k) plan with company match

Paid time off

Flexible work hours

Job summary

Comfort Medical, LLC is seeking a Regulatory & Payer Operations Support Specialist to lead office-level regulatory, payer, and operational support. You will manage Medicaid and payer coordination, survey readiness, insurance verification, prior authorizations, audits, and medical records retrieval.

This role collaborates with clinical, revenue cycle, and regulatory teams to ensure compliance, operational efficiency, and exceptional service to patients and customers.

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.
• Overtime may be required for high performers.
• One year or more paid experience in distribution or dispensing of prescription drugs or devices.
• Must provide high school diploma or equivalent.

Responsibilities

• Regulatory Affairs: Serve as local contact for CMS, Medicaid, accreditation, and payer surveys.
• Maintain survey readiness and regulatory compliance with licensing and company requirements.
• Coordinate mock surveys, compliance audits, and readiness assessments; report findings.
• Maintain regulatory documentation and support leadership in compliance monitoring.
• Medicaid & Payer Relations: Monitor Medicaid regulations and payer policies in territory.
• Act as liaison between local office, Medicaid agencies, and payer teams; support issue resolution.
• Support eligibility, authorizations, documentation, reimbursement, and claims.
• Provide updates on payer requirements and regulatory changes.
• Insurance Verification & Prior Authorization: Verify eligibility and benefits for patients.
• Submit, track, and follow up on prior authorization requests with payers.
• Communicate authorization status to patients, providers, and stakeholders.
• Document eligibility determinations, approvals, denials, and appeals.
• Audit Response & Medical Records: Collect documentation for audits and regulatory reviews.
• Chase missing medical records with providers; ensure completeness prior to submission.
• Maintain audit trackers and response deadlines.
• Office Administrative Support: Coordinate daily office operations and compliance tasks.
• Support onboarding, training, and personnel documentation management.
• Maintain office records, logs, reports, equipment, and resources.
• Promote ethical conduct and compliance with policies and regulations.
• Perform other duties as assigned.

Skills

Medicaid

Medicare

payer operations

revenue cycle

healthcare reimbursement

regulatory compliance

insurance verification

prior authorization

payer communications

audits & surveys

communication skills

organization

problem solving

multi-tasking

high school diploma

Education

Associate or bachelor’s degree in healthcare administration or related field

High school diploma or equivalent

Tools

Microsoft Office

Job description

Comfort Medical, LLC is seeking a Regulatory & Payer Operations Support Specialist to lead office-level regulatory, payer, and operational support. You will manage Medicaid and payer coordination, survey readiness, insurance verification, prior authorizations, audits, and medical records retrieval.

This role collaborates with clinical, revenue cycle, and regulatory teams to ensure compliance, operational efficiency, and exceptional service to patients and customers.