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 environments.
• Excellent communication and interpersonal skills, with the ability to work effectively with internal and external stakeholders; frequent proofreading and checking documents for accuracy.
• Highly organized, self-motivated, and detail-oriented, demonstrating a proactive approach to compliance and privacy matters.
• Ability to manage sensitive information with discretion and professionalism, always ensuring confidentiality and data security.
• Passion for continuous learning and growth, with a dedication to social impact.

What would be a plus:

• Deep familiarity with:
  • CMS regulations and guidance.
  • State Medicaid programs (e.g., DHCS).
  • HIPAA and healthcare privacy requirements.
• Working knowledge of:
  • Coding standards (CPT, ICD-10, HCPCS).
  • Fraud, waste, and abuse (FWA) frameworks.
  • False Claims Act and enforcement risk areas.
• Experience supporting or participating in audits, investigations, or regulatory reviews.
• Experience with managed care contracts or delegated risk models.
• Exposure to clinical operations or behavioral health services.
• Familiarity with GRC platforms (e.g., OneTrust, ServiceNow IRM).
• Experience integrating compliance, audit, and risk programs.
• Experience with privacy frameworks such as GDPR, CCPA, or HIPAA is highly desirable.
• Knowledge, or training in healthcare compliance is strongly desired.
• Familiarity with compliance management tools and database systems.
• Demonstrated ability to drive process improvements and implement best practices in a compliance or privacy-focused environment. Knowledge of healthcare clinical operations, revenue cycle systems, healthcare billing & coding requirements, or other healthcare compliance issues.
• Ability to consistently demonstrate good judgment and decision-making skills while maintaining the highest levels of confidentiality.
• Ability to work in an exciting, fast paced high energy environment while effectively multitasking and managing day-to-day responsibilities without supervision.
• Demonstrate ability to organize, plan and coordinate workflow of others, and to work effectively with all stakeholders to achieve compliance with objectives.

Requests:

• Must be able to communicate effectively within the work environment, read and write using the primary language within the workplace.
• Visual and auditory ability to work with clients, staff and others in the workplace continuously.
• Frequent speaking and listening (25-75%) to clients, staff, and others in the workplace.
• Utilize computer and cell phone for effective communication.

Knowledge, Skills & Abilities (organized by our company values): 

Community oriented: 

• Appreciates and demonstrates collaboration across teams. 
• Serves as a role model, bringing our core values to life in your work. 
• Work in an exciting, fast paced high energy environment while effectively multitasking and managing day-to-day responsibilities without supervision.
• Personable; able to work comfortably with individuals at all levels within the organization.
• Excellent verbal and writing communication skills; frequent proofreading and checking documents for accuracy.

Equity informed:

• Approaches work with a growth mindset, welcome feedback, and understand that humans all have biases and are imperfect as a baseline. 
• Sensitivity to working with an ethnically, linguistically, culturally, and economically diverse population.

Bold:

• Navigates ambiguity with an excitement for problem solving. 
• Commitment to meet agreed upon deadlines on time or ahead of schedule. 
• Transparent on action, pursuits, and outcomes.
• A commitment to the values of the organization while demonstrating good judgment, flexibility, patience and discretion when dealing with confidential and sensitive matters.

Wellbeing driven:

• Willingness and commitment to self-reflection and re-thinking.  
• Ability to understand your physical, mental, social, and financial wellbeing needs with a willingness to co-create boundaries that allow you to sustainably show up and honor your humanity.
• Capacity to contribute to and help cultivate effective + sustainable wellbeing driven spaces.
• Commitment to managing a remote schedule that aligns with PST business hours, ensuring your availability supports a healthy team rhythm and effective cross-functional partnership.

Conditions of Employment

• Ability to obtain and maintain criminal record clearance through the Department of Justice (DOJ). The People & Performance Department must analyze DOJ/FBI live scan reports in accordance with applicable Federal, State, and Local laws, as well as fitness for the position.
• Ability to obtain and maintain clearance through the Office of Inspector General.
• Must attend any required training.

Time Type:

Full time

Compensation:

$113,000 - $153,000 Annually

The statements contained in this job description reflect general details as necessary to describe the principal functions of this job. It should not be considered an all-inclusive listing of work requirements. Individuals may perform other duties as assigned, including work in other functional areas as deemed fit for the organization.