Senior Regulatory Compliance and Revenue Cycle Analyst

Catalight • CA Out of Area Remote, NC

1d • $113,000 - $153,000 • Remote

About The Position

This role sits at the intersection of regulatory privacy and compliance, health plan operations, and revenue cycle integrity. The Senior Regulatory Compliance & Revenue Cycle Analyst is responsible for advancing compliance across payer relationships, reimbursement practices, and healthcare regulatory frameworks, while supporting enterprise-wide GRC privacy and compliance initiatives. This individual will play a critical role in ensuring compliance with federal and state healthcare program requirements, strengthening billing and coding integrity, and embedding privacy and compliance into operational workflows. This is a high-impact, cross-functional role ideal for a compliance professional who understands how regulatory requirements translate into real-world healthcare operations, financial sustainability, and patient outcomes.

Requirements

• 5+ years of experience in healthcare regulatory compliance, revenue cycle, or health plan operations.
• Demonstrated expertise in billing, coding, reimbursement, and/or payment integrity.
• Strong knowledge of government healthcare programs (e.g., Medicare, Medicaid/Medi-Cal).
• Experience working in or with: Managed care organizations (MCOs).
• Provider networks or delegated entities.
• Healthcare services organizations.
• Third-party vendors, business associates, or subcontracted service providers supporting healthcare operations.
• Strong analytical and problem-solving skills with the ability to interpret and apply legal and regulatory requirements in multi-jurisdictional regulatory environments.
• Excellent communication and interpersonal skills, with the ability to work effectively with internal and external stakeholders; frequent proofreading and checking documents for accuracy.
• Highly organized, self-motivated, and detail-oriented, demonstrating a proactive approach to compliance and privacy matters.
• Ability to manage sensitive information with discretion and professionalism, always ensuring confidentiality and data security.
• Passion for continuous learning and growth, with a dedication to social impact.
• Must be able to communicate effectively within the work environment, read and write using the primary language within the workplace.
• Visual and auditory ability to work with clients, staff and others in the workplace continuously.
• Frequent speaking and listening (25-75%) to clients, staff, and others in the workplace.
• Utilize computer and cell phone for effective communication.
• Appreciates and demonstrates collaboration across teams.
• Serves as a role model, bringing our core values to life in your work.
• Work in an exciting, fast paced high energy environment while effectively multitasking and managing day-to-day responsibilities without supervision.
• Personable; able to work comfortably with individuals at all levels within the organization.
• Excellent verbal and writing communication skills; frequent proofreading and checking documents for accuracy.
• Approaches work with a growth mindset, welcome feedback, and understand that humans all have biases and are imperfect as a baseline.
• Sensitivity to working with an ethnically, linguistically, culturally, and economically diverse population.
• Navigates ambiguity with an excitement for problem solving.
• Commitment to meet agreed upon deadlines on time or ahead of schedule.
• Transparent on action, pursuits, and outcomes.
• A commitment to the values of the organization while demonstrating good judgment, flexibility, patience and discretion when dealing with confidential and sensitive matters.
• Willingness and commitment to self-reflection and re-thinking.
• Ability to understand your physical, mental, social, and financial wellbeing needs with a willingness to co-create boundaries that allow you to sustainably show up and honor your humanity.
• Capacity to contribute to and help cultivate effective + sustainable wellbeing driven spaces.
• Commitment to managing a remote schedule that aligns with PST business hours, ensuring your availability supports a healthy team rhythm and effective cross-functional partnership.
• Ability to obtain and maintain criminal record clearance through the Department of Justice (DOJ).
• The People & Performance Department must analyze DOJ/FBI live scan reports in accordance with applicable Federal, State, and Local laws, as well as fitness for the position.
• Ability to obtain and maintain clearance through the Office of Inspector General.
• Must attend any required training.

Nice To Haves

• Deep familiarity with: CMS regulations and guidance.
• State Medicaid programs (e.g., DHCS).
• HIPAA and healthcare privacy requirements.
• Working knowledge of: Coding standards (CPT, ICD-10, HCPCS).
• Fraud, waste, and abuse (FWA) frameworks.
• False Claims Act and enforcement risk areas.
• Experience supporting or participating in audits, investigations, or regulatory reviews.
• Experience with managed care contracts or delegated risk models.
• Exposure to clinical operations or behavioral health services.
• Familiarity with GRC platforms (e.g., OneTrust, ServiceNow IRM).
• Experience integrating compliance, audit, and risk programs.
• Experience with privacy frameworks such as GDPR, CCPA, or HIPAA is highly desirable.
• Knowledge, or training in healthcare compliance is strongly desired.
• Familiarity with compliance management tools and database systems.
• Demonstrated ability to drive process improvements and implement best practices in a compliance or privacy-focused environment.
• Knowledge of healthcare clinical operations, revenue cycle systems, healthcare billing & coding requirements, or other healthcare compliance issues.
• Ability to consistently demonstrate good judgment and decision-making skills while maintaining the highest levels of confidentiality.
• Ability to work in an exciting, fast paced high energy environment while effectively multitasking and managing day-to-day responsibilities without supervision.
• Demonstrate ability to organize, plan and coordinate workflow of others, and to work effectively with all stakeholders to achieve compliance with objectives.

Responsibilities

• Interpret and operationalize requirements across CMS, Medi-Cal (DHCS), DMHC, and other federal/state regulators.
• Support compliance related to managed care contracts, delegated entities, and provider network operations.
• Monitor and assess regulatory changes impacting health plans, reimbursement models, and care delivery.
• Partner with legal, operations, and finance teams to ensure regulatory alignment in contracts and business practices.
• Lead compliance oversight for billing, coding, documentation, and reimbursement practices.
• Evaluate controls related to claims submission, denials management, and payment integrity.
• Identify and mitigate risks related to overpayments, underpayments, and False Claims Act exposure.
• Support internal reviews and audits of revenue cycle processes, including root cause analysis and remediation.
• Collaborate with Internal Audit and Enterprise Risk to align compliance monitoring with audit plans and enterprise risks.
• Support and/or lead targeted compliance audits and assessments (e.g., coding, documentation, regulatory adherence).
• Contribute to enterprise risk assessments related to regulatory, financial, and operational risks.
• Assist in developing controls, KPIs, and monitoring frameworks tied to compliance and revenue cycle performance.
• Support compliance with HIPAA, HITECH, and applicable state privacy laws.
• Evaluate data use practices tied to billing, reporting, and payer interactions.
• Participate in privacy incident response and investigations as needed.
• Provide practical guidance to clinicians and operational leaders on privacy requirements affecting documentation, care coordination, communications, and disclosures.
• Conduct and support due diligence for vendors.
• Assess compliance risks related to outsourced billing, vendors, and delegated entities.
• Develop and maintain policies, procedures, and training related to regulatory and revenue cycle compliance.
• Drive process improvements that enhance compliance while enabling operational efficiency.
• Translate complex regulatory requirements into clear, actionable guidance for business teams.
• Develop or support privacy guidance, FAQs, and training materials to address recurring clinician and operational compliance questions.

Benefits

• The statements contained in this job description reflect general details as necessary to describe the principal functions of this job. It should not be considered an all-inclusive listing of work requirements. Individuals may perform other duties as assigned, including work in other functional areas as deemed fit for the organization.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed