Senior Regulatory Compliance Analyst
Vālenz® Health
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteJob Level
Senior
About the role
- Lead internal audits, operational reviews, and risk assessments, including pre- and post-implementation evaluations.
- Manage the development, revision, and documentation of compliance policies, procedures, and training materials.
- Serve as the primary intake for compliance-related questions, Hotline submissions, and incident reports; provide timely, well-reasoned recommendations.
- Collaborate with leadership on mitigation plans and root cause analysis tied to regulatory or contractual noncompliance.
- Represent Compliance in client-facing meetings, audits, and business reviews.
- Monitor and interpret applicable laws, regulations, and delegation requirements (ERISA, HIPAA, CMS, HHS-OCR, DOL, URAC, NCQA), translating them into practical guidance.
- Review healthcare claims, coding structures (ICD-10, DRG, CPT), and workflows to identify risks and ensure compliance.
- Support vendor and third-party compliance documentation, including audit coordination and follow-up.
- Maintain compliance logs, records, and investigation documentation.
- Assist with board-level reporting, internal committee materials, and responses to payer/client audits of delegated functions.
- Serve as a trusted compliance partner to operational, legal, and product teams.
- Contribute to scalable compliance processes, onboarding, and training for future compliance staff.
Requirements
- Bachelor’s degree in healthcare administration, legal studies, public policy, or related field
- 5+ years of healthcare compliance experience
- Strong knowledge of federal and state healthcare regulatory frameworks (ERISA, Medicare, HIPAA, state-level utilization/case management)
- Experience with claims review and healthcare coding standards
- Ability to work independently, manage competing priorities, and provide actionable real-time guidance
- Proven ability to lead complex projects and serve as a subject matter expert within cross-functional teams
- A plus if you have: CHC (Certified in Healthcare Compliance) highly preferred.
- CPC (Certified Professional Coder) highly preferred.
- Experience in managed care, self-insured plans, stop-loss administration, or TPA operations.
- Prior work in a growing or fast-paced organization; start-up experience.
- Familiarity with cross-functional collaboration across Legal, Product, and Operational teams.
- Experience building compliance frameworks or training others in area-specific requirements.
Benefits
- Competitive benefits package with generous employer subsidies
- Flexible and remote working options
- 401k with generous employer match and immediate vesting
- Personal and professional development opportunities
- Supportive family benefits, including paid leave for new family members
- Companywide philanthropic program, Valenz Communities Connection
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
healthcare complianceclaims reviewhealthcare coding standardsICD-10DRGCPTrisk assessmentscompliance policiesmitigation plansroot cause analysis
Soft skills
independent workmanaging competing prioritiesactionable guidanceleading complex projectscross-functional collaborationcommunicationproblem-solvingtraining otherstrustworthinessadaptability
Certifications
CHCCPC