Regulatory Compliance Specialist (Healthcare)

Location: Remote

Salary: $50,000–$65,000 per year

Company

hirify.global provides Mobility and Personal Care Services in a regulated healthcare environment.

What you will do

• Lead responses to external audits, investigations, and information requests from Medicaid and other government oversight entities.
• Assess request scope, establish workplans, track dependencies, and manage multiple deadlines through final submission.
• Coordinate with Legal, Compliance, Operations, Claims, Finance, IT, Provider Management, and other stakeholders to collect responsive records and data.
• Review, reconcile, and validate claims, trip, service, billing, payment, provider, contract, and policy records.
• Prepare response packages containing data files, exhibits, indexes, summaries, chronologies, and draft written responses.
• Maintain secure repositories, audit trails, version control, and complete records of submissions and follow-up requests.

Requirements

• Bachelor's degree in a related field preferred; equivalent relevant experience may be considered.
• Three or more years of experience in healthcare audit, regulatory response, compliance, investigations, project management, healthcare operations, or a related field.
• Experience managing external audits, regulatory inquiries, investigations, or compliance-driven projects in healthcare or another highly regulated environment.
• Strong knowledge of Medicaid, healthcare claims, healthcare operations, fraud, waste and abuse concepts, and regulatory oversight processes.
• Advanced proficiency with Microsoft Excel and Microsoft Office, including data analysis, reconciliation, filtering, pivot tables, lookups, and supporting schedules.
• Strong analytical, written communication, judgment, organization, and cross-functional collaboration skills.

Nice to have

• Direct experience responding to MFCU, UPIC, DOJ, OIG, Attorneys General, state Medicaid, or managed care organization requests.
• Experience with NEMT, mobility, personal care, home care, managed care, claims data, or healthcare documentation.
• Project management, audit, compliance, healthcare data, or fraud, waste, and abuse training or certification.
• Experience with reporting, data visualization, or other tools for working with large datasets.

Culture & Benefits

• Medical, dental, and vision insurance.
• Employer-paid life insurance, AD&D, disability coverage, and flexible spending accounts.
• 401(k) retirement savings plan with company match.
• Paid time off, paid parental leave, tuition reimbursement, and employee discounts.
• Primarily seated computer and telephone work with reasonable accommodations available for qualified individuals with disabilities.