The Manager, Regulatory & Payer Operations Support provides leadership and oversight for the Regulatory & Payer Operations Specialist team. The role ensures regulatory readiness, payer operations excellence, audit support, authorization and eligibility support functions, compliance adherence, and operational consistency across supported locations.
Major Areas of Accountability- Lead, coach, and develop Regulatory & Payer Operations Specialists.
- In coordination with other teams, will ensure proper staffing at all office locations and will ensure that offices are staffed during periods of PTO and staff development.
- Manage staffing, performance evaluations, training, and workforce planning.
- Working with the Manager, Payer Credentialing, will manage ensure office survey readiness and compliance with CMS, Medicaid, accreditation, licensing, and company requirements.
- Monitor regulatory and payer changes and coordinate implementation activities.
- Oversee insurance verification, benefits investigation, and prior authorization support processes of direct reports.
- Escalate and resolve complex payer, eligibility, authorization, and reimbursement issues.
- Direct team in support of audit response coordination and medical record retrieval efforts.
- Develop operational metrics, reporting, and performance dashboards.
- Partner with Revenue Cycle, Compliance, Operations, Credentialing, and Payer Relations leadership.
- Identify and communicate process improvement opportunities.
- Comfort Medical employees are required to conduct business to the highest ethical and professional standards; comply with applicable laws and regulations, the MedTech Code of Conduct, and company policies.
- Other job duties as assigned.
Basic Qualifications- Minimum 5 years of experience in healthcare reimbursement, payer operations, regulatory affairs, compliance, revenue cycle, or healthcare operations.
- Minimum 2 years of leadership experience.
- Minimum 2 years of DME experience.
- Experience managing audits, compliance programs, or payer operations functions.
- Knowledge of Medicare, Medicaid, and commercial payer processes.
- Strong communication, analytical, organizational, and project management skills.
- Proficiency in Microsoft Office applications.
Preferred Qualifications- Bachelor's degree in healthcare administration, Business Administration, Public Health, Regulatory Affairs, or related fields.
- Experience in DMEPOS, HME, home health, or other regulated healthcare environments.
- Experience supporting multi-location healthcare operations.
- Knowledge of accreditation standards and survey processes.
- 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 compensation range for this position is $95,898 - $143,847. Actual compensation is influenced by a variety of factors including but not limited to skills, experience, qualifications, and geographic location. Hired candidates may be eligible to receive additional compensation in the form of bonuses and/or incentives.
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.
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