Senior Regulatory Compliance and Revenue Cycle Analyst

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.

Essential Job Functions

Regulatory Compliance (Health Plan & Government Programs)

• 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.

Revenue Cycle & Billing Compliance

• 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.

Integrated GRC & Audit Support

• 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.

Privacy, Data Use & Regulatory Alignment

• 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.

Third-Party & Vendor Compliance

• Conduct and support due diligence for vendors.
• Assess compliance risks related to outsourced billing, vendors, and delegated entities.

Program Development & Continuous Improvement

• 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.

Qualifications

Minimum Education, Experience & Training Equivalent to:

We believe humans with a diverse range of experiences may be suited for the work at hand. We are avoiding education minimums with an acknowledgment that these can be barriers for historically excluded groups. We’re looking for someone who brings deep expertise in people-centered work and is excited to grow with us. This role is well suited for someone who has:

• 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 environme