Senior Compliance Specialist (Healthcare)

TL;DR

Senior Compliance Specialist (Healthcare): Providing risk-based compliance oversight for payment integrity and clinical operations with an accent on regulatory requirements, FWA frameworks, and accreditation standards. Focus on ensuring adherence to CMS, HIPAA, and multi-state licensing regulations while supporting audit readiness and policy governance.

Location: Must be US based

Company

hirify.global is a healthcare platform simplifying the patient journey through integrated solutions for employers, payers, and providers to reduce costs and improve quality.

What you will do

• Serve as the primary compliance liaison for Payment Integrity, Payment Operations, and Care Management teams.
• Interpret and operationalize regulatory standards including the No Surprises Act, FWA laws, CMS requirements, and NCQA/URAC accreditation standards.
• Provide compliance oversight for payment workflows, claims administration, and clinical operations.
• Support multi-state utilization management licensing programs and regulatory change management.
• Coordinate internal and external audits, regulatory examinations, and incident response activities.
• Develop and deliver compliance training and guidance to internal stakeholders.

Requirements

• Bachelor’s degree required in Healthcare Administration, Finance, Business, Nursing, or related field.
• 5+ years of experience in healthcare compliance, regulatory affairs, or related operations.
• Certified Professional Coder (CPC) or equivalent coding certification.
• Demonstrated knowledge of healthcare billing, coding, reimbursement, and FWA frameworks.
• Strong understanding of CMS regulatory frameworks and managed care compliance.
• Must be US based and able to comply with HIPAA and company security protocols.

Nice to have

• Experience with No Surprises Act (NSA) implementation and oversight.
• Clinical background (e.g., Registered Nurse).
• Professional certifications such as CHC, CFE, or CPHQ.
• Experience with 42 CFR Part 2 requirements.

Culture & Benefits

• Generously subsidized Medical, Dental, and Vision insurance.
• 401K with company match and immediate vesting.
• Flexible working environment with provided equipment.
• Generous Paid Time Off including vacation, sick leave, and paid holidays.
• Paid maternity and paternity leave.
• Employee Assistance Program and pet insurance.