Regulatory & Payer Operations Support Specialist

The 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 Accountability Regulatory Affairs Serve 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 Relations Monitor 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 Support Conduct 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 Support Coordinate 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 Support Coordinate 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 Qualifications Minimum 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. Occasionally, employees currently recognized as high performers through recent performance evaluations, or employees with current demonstrated productivity leadership compared to other employees on existing metrics may be asked to engage in overtime. Must have one year or more paid experience related to the distribution or dispensing of prescription drugs or prescription devices. Must be able to provide a physical or electronic copy of your High school diploma or equivalent. Preferred Qualifications Associate 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. Here is some of what you can expect: Health and Wellness: Comprehensive medical, dental, and vision insurance plans to keep you and your family healthy. Plus, access to company sponsored wellness programs and mental health resources, paid leave of absence for qualifying events and generous paid parental leave for both birthing and non-birthing parents. Financial Security: A competitive 401(k) plan with company match that vest immediately, financial planning services to help you secure your future, and corporate discount programs for goods and services. Work-Life Balance: Generous paid time off, flexible work hours, and flexible work arrangement options to help you balance your personal and professional life may be available. Professional Development: Opportunities for continuous learning and career advancement through training programs, mentorship, and tuition reimbursement. Recognition and Rewards: Recognition programs to celebrate achievements and contributions, including peer recognition, bonuses, awards, and special events. Community and Culture: A supportive work environment where everyone feels valued, and has a sense of belonging. Participate in team-building activities, volunteer opportunities, and company-sponsored events. Sustainability strategy that outlines our ambitions for how to run our company in a more sustainable way. Competitive Compensation: The starting hourly rate for this position is $24.07. Hired candidates may be eligible to receive additional compensation for applicable experience and may also be eligible for bonuses and/or incentives. Actual compensation is influenced by a variety of factors including but not limited to skills, experience, qualifications, and geographic location. Comfort Medical provides an extensive selection of name brand catheter and ostomy supplies to thousands of customers nationwide. Our attention to detail, unmatched customer service, and dedication to helping our customers live happier, healthier lives are just a few of the many reasons we are one of the fastest growing catheter and ostomy supply companies in the nation! Comfort Medical employees are required to conduct business to the highest ethical and professional standards; comply with applicable laws and regulations, the Advamed Code of Ethics on Interactions with Healthcare Professionals, and company policies. Comfort Medical is committed to a policy of Equal Employment Opportunity (EEO) which means we employ and promote individuals based on their merits, regardless of race, color, religion, sex, national origin, age, disability, veteran status, pregnancy, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status, status with regards to public assistance or any other protected classification. #J-18808-Ljbffr