Regulatory Compliance Analyst

HealthEdge•Remote,

1d•$75,000 - $95,000•Remote

About The Position

This position is responsible for supporting the organization and clients in meeting Federal and State regulatory requirements through audit readiness, audit management, and corrective action plan (CAP) execution. The role supports compliance initiatives by leading and coordinating internal and external audits, monitoring audit-related regulatory guidance, and managing the lifecycle of corrective action plans tied to Medicare and Medicaid healthcare programs. The role works cross-functionally with key stakeholders such as claims, enrollment, utilization management, risk adjustment, client success, product owners, vendors, and other areas to ensure audit findings are resolved and CAPs are closed in accordance with CMS and state regulatory guidelines.

Requirements

Bachelor’s degree in healthcare administration, public health or related field.
Minimum of four (4) years of managed care, healthcare operations, or regulatory compliance.
Working knowledge of Medicare, Medicaid, and ACA health plan regulations along with related federal and state laws.
Demonstrated experience developing and managing Corrective Action Plans, including root cause analysis and remediation tracking.
Strong interpersonal skills and the ability to collaborate with colleagues at all levels.
Excellent analytical, organizational, and communication skills, with strong attention to detail.
Ability to prioritize and manage multiple cross-functional audit and CAP priorities simultaneously.
Proficiency in Microsoft Excel, Word, PowerPoint, and audit/CAP tracking or case management tools.

Nice To Haves

Certification in healthcare compliance (CHC) preferred
Experience supporting or leading CMS Program Audits, state audits, or client audits preferred.

Responsibilities

Coordinate and support internal and external audits, including CMS Program Audits, state audits, delegation oversight audits, and client-driven audits.
Monitor, interpret, and track CMS guidance such as Final Rules, HPMS memos, audit protocols, and Federal Register communications impacting audit and CAP obligations for Medicare Advantage, Medicaid, and other healthcare programs.
Develop, draft, and manage Corrective Action Plans (CAPs) in response to audit findings, self-identified issues, or regulatory notices, ensuring root cause analysis, remediation steps, and monitoring plans are clearly documented.
Track CAP milestones, deliverables, and deadlines to ensure timely submission and closure with CMS, state agencies, or clients.
Communicate audit findings, CAP status, and regulatory requirements to internal and external stakeholders.
Prepare audit readiness materials, universe pulls, and supporting documentation for regulatory and client audits.
Oversee and maintain the organization's audit and CAP tracking/distribution process, including centralized logs of open findings and remediation status.
Partner with internal business and product stakeholders to validate corrective actions and confirm sustained compliance post-remediation.
Maintain audit and CAP documentation, evidence files, and implementation timelines in accordance with recordkeeping requirements.
Track resolution of identified compliance risks and escalate unresolved or high-risk findings appropriately.
Support the development of desk-level procedures, audit playbooks, presentations, and training materials related to audit and CAP processes.