HealthEdge
HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.
Healthcare Technology
Regulatory Compliance Principal
March 21
HealthEdge
HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.
Healthcare Technology
📋 Description
• The Regulatory Compliance Principal will be the subject matter expert in healthcare regulatory compliance. • This individual will play a pivotal role in ensuring that our suite payer-focused software products support our customers in achieving and maintaining compliance with federal, state, and accreditation body requirements. • The Director, Regulatory Compliance will serve as a strategic advisor to internal and external stakeholders, driving regulatory adherence and aligning our products with the ever-evolving healthcare landscape.
🎯 Requirements
• Bachelor’s degree in a healthcare-related field required; advanced degree (e.g., law, clinical) preferred. • 7+ years of experience in healthcare compliance, with a focus on Medicare, Medicaid, NCQA, CMS, URAC, and state regulatory requirements. • Extensive experience in the payer space, with knowledge of health plan operations and their digital transformation needs. • Demonstrated experience working with regulatory requirements in a software product development environment. • Advanced understanding of healthcare regulations, including HEDIS, CMS reporting, and audit requirements. • Ability to interpret complex regulations and translate them into actionable business solutions. • Strong interpersonal, communication, organizational, and coordination skills. • Analytical and storytelling capabilities to educate and align internal and external audiences on compliance matters. • Proven ability to work independently, collaboratively, and as a team leader.
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