Sr. Compliance Specialist - Payment Integrity

Vālenz® Health is the platform to simplify healthcare – the destination for employers, payers, providers and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey – from care navigation and management to payment integrity, plan performance and provider verification. With a 99% client retention rate, we elevate expectations to a new level of efficiency, effectiveness and transparency where smarter, better, faster healthcare is possible.

About This Opportunity:
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.



Things You’ll Do Here:

• 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.

• 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 billi