Manager, Regulatory Compliance
About The Position
HealthEdge is seeking a Manager, Regulatory Compliance to lead a team supporting HealthEdge Source™, its reference data and pricing transparency platform. The manager oversees professionals who monitor, interpret, document, and operationalize federal and state regulatory requirements affecting commercial, Medicare Advantage, and Medicaid lines of business. The role focuses on building team capability, maintaining high-quality regulatory outputs, and delivering consistently amid an evolving regulatory landscape. The manager leads workload planning, prioritization, development, and performance management for a team of claims pricing, editing, reference data, and regulatory subject matter experts. They serve as an escalation point for complex Source-related regulatory issues and partner with Product, Engineering, Client Success, and Implementation teams to translate requirements into product plans, releases, and client support. The position is remote in the United States, full-time and permanent, and classified as exempt. Travel may be required depending on company needs. The annual US base salary range is $148,000 to $156,000; final compensation depends on factors including skills, experience, qualifications, and education.
Requirements
- Bachelor’s degree or equivalent combination of education and experience.
- 8+ years of experience in healthcare regulatory compliance, healthcare operations, managed care, or a related field.
- 5+ years of progressive people leadership experience, including leading teams of highly specialized professionals.
- Demonstrated success building team capability, managing performance, and developing staff in a technical or compliance environment.
- Experience working within or in support of a healthcare technology or managed care organization.
- Working knowledge of claims pricing, editing, and reference data concepts.
- Familiarity with Transparency in Coverage requirements, including MRF obligations, schema versioning, and in-network and out-of-network file content standards.
- Ability to translate regulatory requirements into clear, actionable guidance for team members and cross-functional partners.
- Strong people management skills, including coaching, feedback, performance management, and team building.
- Strong organizational and prioritization skills, with the ability to manage multiple workstreams and release deadlines.
- Clear written and verbal communication skills, including the ability to summarize complex regulatory content for varied audiences.
Nice To Haves
- Experience supporting healthcare SaaS products or healthcare technology platforms.
- Familiarity with HealthEdge Source™ or comparable claims pricing, editing, reference data, and pricing transparency platforms.
- Knowledge of CMS regulations, NCQA accreditation standards, interoperability requirements, HL7 FHIR, TEFCA, HIPAA, and related healthcare compliance frameworks.
- Experience supporting core administration platforms, care management solutions, or digital health technologies.
- Familiarity with Agile product development methodologies and regulatory-driven release management.
- Experience leading organizational transformation, functional redesign, or large-scale compliance initiatives.
Responsibilities
- Lead, supervise, coach, and develop a team of regulatory compliance professionals with expertise in claims pricing, reference data, and healthcare transparency requirements.
- Conduct regular one-on-ones, performance reviews, and career development conversations.
- Build a team culture grounded in accountability, intellectual rigor, collaboration, and continuous improvement.
- Plan workload, capacity, and coverage to meet regulatory timelines, product release commitments, and data release cycles.
- Drive onboarding and skill development as Source’s regulatory scope evolves.
- Oversee monitoring, interpretation, and documentation of federal and state regulatory requirements affecting pricing, reference data, and editing.
- Ensure system requirement specifications and client-facing materials are accurate, timely, and meet quality standards.
- Manage review and disposition of regulatory changes relevant to Source across commercial, Medicare Advantage, and Medicaid lines of business.
- Oversee escalation and resolution of complex regulatory issues affecting Source customers or product functionality.
- Partner with Source Product and Engineering to incorporate regulatory requirements into roadmap planning and sprint execution.
- Collaborate with Client Success and Implementation teams on health plan client inquiries related to Source regulatory content.
- Represent the team in cross-functional meetings, regulatory forums, and client-facing engagements as needed.
- Coordinate enterprise regulatory monitoring and cross-product impact assessments where Source data intersects with other HealthEdge platforms.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
