Sr. Compliance Specialist - Payment Integrity

Valenz•Phoenix, AZ

1d•Remote

About The Position

As a Sr. Compliance Specialist - Payment Integrity (aka Sr. Product Compliance Specialist - Payment Integrity), you'll support Payment Integrity and Payment Operations as the primary compliance lead for regulatory requirements impacting claims, billing, reimbursement, and payment activities. You'll provide risk-based compliance oversight for areas including the No Surprises Act (NSA), Fraud, Waste & Abuse (FWA), regulatory change management, operational initiatives, and other payment-related processes. You'll partner closely with Product, Operations, and Corporate Compliance teams to support policy governance, compliance training, issue intake management, and ongoing efforts to ensure compliance with applicable state and federal regulations.

Requirements

Bachelor’s degree required; concentration in Healthcare Administration, Finance, Business Administration, or a related field preferred.
5+ years of progressive experience in healthcare compliance, payment integrity, regulatory compliance, or related healthcare operations.
Certified Professional Coder (CPC) credential or equivalent coding certification.
Demonstrated knowledge and experience with claims processing operations and/or payment integrity programs.
Demonstrated knowledge of healthcare billing, coding, and reimbursement regulations.
Demonstrated experience with Fraud, Waste & Abuse (FWA) compliance frameworks and investigative processes

Nice To Haves

Experience supporting No Surprises Act (NSA) implementation, oversight, and compliance activities.
Experience within Payment Integrity, health plan, payer-side, or managed care operations.
Familiarity with CMS programs, regulatory requirements, and enforcement priorities impacting claims and payment oversight.
Experience operating within a Business Associate environment and supporting HIPAA-related compliance obligations.
Professional certifications such as Certified in Healthcare Compliance (CHC), Certified Fraud Examiner (CFE), CPC, or other relevant healthcare compliance credentials.

Responsibilities

Serve as the primary compliance liaison for Payment Integrity and Payment Operations, providing strategic guidance on regulatory and operational compliance matters.
Interpret, analyze, and operationalize applicable regulatory requirements, including the No Surprises Act (NSA), Fraud, Waste & Abuse (FWA) laws, CMS requirements, and state Department of Insurance (DOI) regulations impacting payment and billing practices.
Provide compliance oversight and guidance related to payment workflows, reimbursement methodologies, claims administration processes, and product development initiatives.
Partner cross-functionally with operational leaders to identify, assess, and mitigate financial and regulatory compliance risks associated with payment and claims functions.
Monitor and evaluate emerging regulatory developments, enforcement trends, and industry guidance to determine operational impact and support implementation of required changes.
Support the development, review, implementation, and maintenance of financial and payment-related policies, procedures, and standard operating procedures (SOPs).
Participate in high-risk initiatives, system implementations, process enhancements, and product changes to ensure compliance considerations are appropriately addressed.
Assist with incident response activities involving payment disputes, FWA-related escalations, regulatory inquiries, and other compliance-related matters.
Support internal audits, external audits, client audits, and regulatory examinations by coordinating documentation, responding to inquiries, and ensuring audit readiness.
Collaborate with Corporate Compliance and cross-functional stakeholders on issue intake, triage, investigation support, tracking, corrective action planning, and resolution activities.
Develop and deliver training, education, and compliance guidance to internal stakeholders regarding applicable regulatory requirements, policies, and operational expectations.
Maintain accurate and organized documentation supporting compliance oversight activities, monitoring efforts, investigations, and audit preparedness.
Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties.

Benefits

Generously subsidized company-sponsored Medical, Dental, and Vision insurance, with access to services through our own products, Healthcare Blue Book and KISx Card.
Spending account options: HSA, FSA, and DCFSA
401K with company match and immediate vesting
Flexible working environment
Generous Paid Time Off to include vacation, sick leave, and paid holidays
Employee Assistance Program that includes professional counseling, referrals, and additional services
Paid maternity and paternity leave
Pet insurance
Employee discounts on phone plans, car rentals and computers
Community giveback opportunities, including paid time off for philanthropic endeavors