Regulatory & Payer Operations Support Specialist (Coral Springs, FL)

Regulatory & Payer Operations Support Specialist (Coral Springs, FL)Location: Coral Springs, FL, US Job Family: Commercial Support Country/Region: United StatesThe Regulatory & Payer Operations Support Specialist serves as the office-level regulatory, payer, and operational support lead. The role is responsible for survey readiness, Medicaid and payer coordination, and will provide operational support with insurance verification, prior authorization support, audit response coordination, medical records retrieval, and office administrative operations. This position partners with clinical, operational, revenue cycle, and regulatory teams to ensure compliance, operational efficiency, and exceptional service to patients and customers.Major Areas of AccountabilityRegulatory AffairsServe as the local point of contact for CMS, Medicaid, accreditation, and payer surveys. Maintain continuous survey readiness and compliance with regulatory, licensing, accreditation, and company requirements. Coordinate mock surveys, compliance audits, and readiness assessments; communicate findings and corrective actions. Maintain regulatory documentation and support office leadership in compliance monitoring.Medicaid & Payer RelationsMonitor and interpret Medicaid regulations, payer policies, and reimbursement requirements within assigned territory. Act as a liaison between the local office, Medicaid agencies, managed care organizations, payer representatives and the Managed Care Access and Credentialing teams. Works cross-functionally to support issue resolution related to eligibility, authorizations, documentation, reimbursement, and claims. Provide updates regarding payer requirements and regulatory changes.Insurance Verification & Prior Authorization SupportConduct insurance eligibility and benefit verification for new and existing patients. Submit, track, and follow up on prior authorization requests with government and commercial payers. Communicate authorization status and requirements to patients, providers, and internal stakeholders. Maintain accurate documentation of eligibility determinations, authorization approvals, denials, and appeals.Audit Response & Medical Records SupportCoordinate collection of supporting documentation for internal audits, payer audits, and regulatory reviews. Perform medical record chase activities with provider offices and clinicians to obtain required records. Ensure completeness and accuracy of records prior to submission. Maintain audit trackers and monitor response deadlines.Office Administrative SupportCoordinate administrative activities supporting daily office operations and compliance. Support onboarding, training coordination, and personnel documentation management. Maintain office records, logs, reports, equipment, and office resources. Promote ethical conduct and compliance with company policies and applicable regulations. Perform other duties as assigned.Basic QualificationsMinimum 2 years' experience with Medicaid, Medicare, payer operations, revenue cycle, healthcare reimbursement, or regulatory compliance.Experience with insurance verification, prior authorization processing, or payer communications.Experience supporting audits, surveys, compliance reviews, or regulatory inspections.Strong Microsoft Office skills and documentation management capabilities.Excellent communication, organization, and problem-solving skills.Ability to manage multiple priorities in a fast-paced healthcare environment.Preferred QualificationsAssociate or bachelor's degree in healthcare administration, Business Administration, Public Health, Regulatory Affairs, or related field.Experience in DMEPOS, HME, home health, or other regulated healthcare environments.Knowledge of CMS, Medicaid, accreditation, and payer requirements.Experience with medical record retrieval, audit responses, claims support, and reimbursement processes.Familiarity with Medicaid managed care organizations and multi-state operations.At Coloplast, we believe in recognizing and rewarding the contributions of our employees. Our total rewards package is designed to support your well-being, foster your professional growth, and ensure a healthy work-life balance.