Compliance & Outcomes Specialist
$140k - $200kHike Medical
The Role The Compliance & Outcomes Specialist is the person who knows why a claim gets denied — and what it takes to make sure it never gets denied again. You maintain full working knowledge of all relevant medical policies across CMS and major commercial payers, track how those policies evolve, and ensure every clinical protocol and agent guide we publish is grounded in current policy and supported by outcomes data. You also track external evidence — peer‑reviewed articles, registry data, payer medical bulletins — and decide when that evidence should change how we build our protocols. What You Will Do Maintain the Hike medical policy library: CMS LCDs/NCDs, Policy Articles, CMS Required PA List, and major commercial payer policies (UHC, Aetna, Cigna, BCBS) for all active and planned categories. Monitor policy changes — CMS transmittals, Medicare Advantage updates, LCD revision cycles — and flag impacted agent guides for update within SLA. Map ICD‑10 codes to qualifying coverage criteria for each device category, and maintain those mappings as policy evolves. Track clinical outcomes data and peer‑reviewed evidence, and advise the Protocol Specialist when evidence should drive protocol changes. Support appeals and redetermination: when a claim is denied, define the documentation and medical necessity argument behind the appeal. Advise on compliance risk in new category expansions: identify payer‑specific landmines before launch. Participate in periodic audits of HITL team review accuracy against compliance standards. What we are looking for 5+ years in healthcare compliance, medical policy, utilization management, or clinical documentation auditing in a DMEPOS or O&P context. Working knowledge of the CMS LCD and Policy Article framework, the CMS Required Prior Authorization List, and major commercial payer policies. Experience reviewing ICD‑10 to HCPCS mappings for coverage accuracy. Familiarity with appeals and redetermination at Medicare FFS and major commercial payers. Ability to synthesize clinical evidence into policy‑relevant summaries. Background at a DMEPOS supplier, O&P company, managed care organization, or payer medical policy team. Compensation Compensation Range: $140K - $200K #J-18808-Ljbffr Hike Medical
- ...advance clinical analytics by analyzing clinical, claims, and operational data to uncover insights that drive improvements in quality, outcomes, and efficiency. The role is hands-on, generating clear analyses and dashboards in Power BI, with strong SQL skills and the...Suggested
- ...WRA's Compliance Monitoring Team was founded in 2019. We work on approximately 50 projects per year throughout Northern California. Our... ...operate with an ownership mindset, taking responsibility for outcomes and being true to our commitments. WRA's company vision is...SuggestedFull timePart timeSecond jobWork at officeLocal areaFlexible hoursShift workNight shift
- Full-Time Advancing Population Health and Equity Outcomes | FUSE Executive Fellowship Priority application deadline: August 14, 2026. San Francisco is committed to addressing health disparities and transforming its public health system to advance equity, ensuring that...SuggestedFull timeLocal area
$28.85 - $30.25 per hour
...Compliance SpecialistAbode, one of the largest and effective nonprofits working to end homelessness in the Bay Area, is seeking a Compliance Specialist for our programs in San Francisco County.About the Role: Under general supervision of the Compliance Coordinator, the...SuggestedContract workRemote work$152k - $187k
...and drive our corporate and commercial transactions. We ensure compliance with an increasingly complex and dynamic range of global... ...At least 5 years of experience working as a trade compliance specialist, preferably in‑house. Experience performing and managing both...SuggestedFull time- ...Astranis seeks a results-driven Trade & Regulatory Compliance Manager to join its legal department in San Francisco, CA. Anchored in U.S. export controls, the role oversees ITAR/EAR, OFAC, FCPA, and FAR/DFARS, partnering with engineering, supply chain, HR and sales to...
- ...Compliance SpecialistThe Compliance Specialist ensures that the regulatory and compliance requirements are met for each property and reports to the Associate Director of Compliance. The position requires a person with knowledge of local, state, and federal affordable...Hourly payFull timeLocal areaMonday to Friday
$150k - $200k
...Overview We're hiring a GRC Senior Analyst to help build the compliance foundation powering the future of global crypto payments. At Mesh... .... Regularly uses AI tools to increase efficiency and improve outcomes across areas such as policy development, process monitoring,...Work at officeRemote work2 days per week$75k - $90k
...experienced professionals committed to delivering exceptional client outcomes. Two Career Opportunities Advisor Development Partner... ...management coaching Advanced technology platform Compliance and operational support Errors & Omissions (E&O) insurance...$60k - $85k
...The California Academy of Sciences seeks an Occupational Health & Safety Specialist responsible for implementing and managing safety programs in San Francisco. This full-time role requires extensive knowledge of Cal/OSHA regulations and the ability to conduct safety inspections...Full time- The John Stewart Company is hiring a Compliance Specialist in San Francisco to oversee eligibility for affordable housing programs. This role requires strong compliance skills and the ability to collaborate with various stakeholders. Applicants should have knowledge of...Work at officeRemote work
- We are seeking a Privacy & Compliance Specialist to build and run Superpower's privacy and compliance program and accelerate our mission. We are looking for someone who cares deeply about protecting member health data, crossing t’s and dotting i’s, and can think at scale...Full timeFixed term contract
- Waymo, a leader in autonomous driving technology, seeks a Trade Compliance Specialist to join our Legal team across U.S. locations. You will manage import/export classifications, develop compliance measures, and support audits for global shipments. The role partners with...
$136k - $192k
...them to grow, optimize time and resources, and deliver superior outcomes for their clients. We’re looking for exceptional talent to... ...and adapt swiftly to change. The opportunity We’re hiring a Compliance Officer to serve as the functional compliance lead for Altruist...Work at officeImmediate start3 days per week- Drug Enforcement Administration (DEA) in San Francisco seeks a specialized evidence management professional to receive, document, store, and dispose of non-drug and drug evidence and stockpiles for the field office. The role requires knowledge of evidence handling standards...Work at office
- ...standards across our products, services and internal operations. We are seeking an experienced and highly motivated Senior Compliance Specialist to help scale our security, privacy and compliance programs. This role will be responsible for maintaining key certifications...Contract workFor contractorsFor subcontractorWork at office
- ...collaborate and thrive, together! Position Summary Flynn Group is seeking a highly proactive, detail-oriented Compliance Operations Specialist (Legal and HR) to support the Compliance team. This highly cross-functional role is responsible for coordinating and...Temporary workCasual workWork at officeLocal areaWork from homeFlexible hours
$140k - $200k
Hike Medical in San Francisco is seeking a Compliance & Outcomes Specialist to manage the medical policy library and ensure compliance with healthcare regulations. The role requires expertise in CMS policies, clinical outcomes tracking, and risk management to support appeals...- ...Position Description: The primary role of the Supplier Quality Specialist is to ensure that foreign suppliers and their imported food products comply with the US federal regulations and compliance requirements. This role supports the ongoing development of the FSVP...Local area
- ...candidate has experience applying data science to impact business outcomes, and enjoys pushing the boundaries to innovate. You will... ...experience working with architects, space planners and interior design specialists Experience working with HR / organizational people data...Local area
- ...delivery across AI projects. You will guide engineering teams, manage discovery sessions, and ensure alignment between promises and outcomes. We value 10+ years in product or engineering leadership, ability to read code, and strong business sense. Expect frequent on-site...
- Jobtailor is seeking a Pharmacy Customer Support Specialist to optimize patient outcomes using Arine's platform. You will manage outbound and inbound communications with patients, providers, and pharmacies, schedule appointments, and resolve medication-related issues. This...
- ...workflows.This is a builder role for someone who wants to own outcomes, not tickets: the person will sit inside the processes they are... ...— cycle time, Fast Pass performance, first-pass yield, policy compliance, automation coverage, and adoption rates — and report against...Worldwide
- Element Fleet Corporation is seeking an Onsite Compliance Associate in San Francisco, California. In this role, you will support the execution of the Strategic Client's vehicle compliance program by ensuring all documentation is accurate and operational workflows are efficiently...Work at office
- The University of California - San Francisco is seeking a Research Compliance Analyst to provide regulatory guidance and support to the research leadership team. This role involves preparing, submitting, and tracking IRB documents for clinical trials and assisting in the...
- OKX is seeking a Compliance professional to lead KYB/CDD activities, reviewing onboarding cases and AML documentation to ensure regulatory alignment. You will verify documents, request CDD/EDD materials, and monitor SLAs while escalating issues when needed. The role requires...
- ...Blockchain to users around the world, through our leading products OKX, OKX Wallet, OKLink and more. About the Opportunity The Compliance function at OKX is responsible for the overall compliance culture at the company. We're a team of risk-minded problem solvers who...
- ...Writing Expert to support an AI-focused project. You will create, review, and evaluate federal and military-style reports, ensuring compliance and clear, actionable content. The role is remote within the United States. You will collaborate with project teams to produce...Remote job
- Rippling is expanding its compliance-focused product and seeks a Senior Sales Consultant who will own onboarding, deliver value through... ...with Sales, Product, and Account Management to ensure customer outcomes and sustainable growth, including risk mitigation and data-...Remote job
- Centers for Medicare & Medicaid Services (CMS) seeks a Grants Management Specialist, GS-1109-9/11, to oversee all grants and cooperative agreements duties within the Office of Acquisition and Grants Management. Responsibilities include detecting deficiencies in grant documentation...Work at office
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Compliance & Outcomes Specialist. Be the first to apply!
- research compliance officer San Francisco, CA
- trade compliance specialist San Francisco, CA
- privacy compliance analyst San Francisco, CA
- senior compliance analyst San Francisco, CA
- regulatory compliance associate San Francisco, CA
- risk compliance officer San Francisco, CA
- regulatory officer San Francisco, CA
- senior regulatory affairs specialist San Francisco, CA
- legal compliance officer San Francisco, CA
- cybersecurity policy and compliance analyst San Francisco, CA

