Regulatory Compliance Specialist

Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you!

The Regulatory Compliance Specialist coordinates and manages the timely, accurate, and secure response to external regulatory audits, investigations, and requests for information involving the organization's Mobility and Personal Care Services businesses.

The role serves as a project lead for requests from entities such as Medicaid Fraud Control Units (MFCUs), Unified Program Integrity Contractors (UPICs), the U.S. Department of Justice (DOJ), Office of Inspector General (OIG), Attorneys General, state Medicaid agencies, and Medicaid managed care organizations (MCOs). The Specialist coordinates with Legal, Compliance, Operations, Claims, Clinical/Personal Care, Finance, Provider Management, IT, and other stakeholders to identify, retrieve, validate, organize, and prepare responsive information, including claims data, trip/service records, billing and payment data, provider records, contracts, rate information, policies, procedures, and supporting documentation.

This position requires strong project management, audit, data analysis, written communication, and judgment skills, with the ability to manage multiple high-priority matters and regulatory deadlines simultaneously.

This role...Serve as the primary coordinator and project lead for external audit, regulatory, investigative, and information requests from MFCUs, UPICs, DOJ, OIG, Attorneys General, state Medicaid programs, MCO clients, and other authorized oversight entities.

Intake and assess each request to understand its scope, applicable business area, population, date range, requested records, response format, due dates, and required stakeholders; establish a documented workplan and response timeline.

Manage multiple concurrent requests from initiation through final submission, maintaining an audit/request tracker, status reporting, action items, dependencies, deliverables, and deadlines to ensure timely completion.

Coordinate cross-functional teams to obtain responsive records and data from Mobility and Personal Care Services operations, including trip logs, service records, claims and encounter data, billing/payment information, provider records, contracts, rate sheets, policies, procedures, and related documentation.

Perform detailed reviews of retrieved records and datasets for completeness, accuracy, consistency, relevancy, and responsiveness to the request; identify gaps, discrepancies, duplicates, or exceptions and coordinate resolution with the appropriate business owners.

Prepare and organize response packages, including data files, supporting records, exhibits, document indexes, summaries, chronologies, and draft written responses, consistent with request requirements and internal review standards.

Coordinate with Legal and Compliance on matters requiring legal interpretation, privilege considerations, regulatory strategy, escalation, or review of proposed responses; promptly escalate potential compliance, fraud, abuse, or material operational issues identified during the response process.

Communicate professionally with internal stakeholders and, when authorized, external requestors to clarify information needs, resolve questions, confirm response requirements, and manage submission logistics and deadlines.

Maintain a secure, organized repository of request-related materials, correspondence, work papers, source data, final response packages, and submission records in accordance with records retention, privacy, security, and document control requirements.

Use Microsoft Excel and other reporting or data tools to analyze large datasets, identify trends or anomalies, reconcile information across systems, and develop clear supporting schedules for regulatory and audit responses.

Support follow-up requests, supplemental documentation, interviews, and additional questions that arise after an initial submission, maintaining version control and a complete record of communications and deliverables.

Identify opportunities to improve the organization's processes for responding to government investigations, regulatory audits, client audits, and information requests, including standardization, tracking, reporting, documentation, and turnaround time.

Maintain current knowledge of applicable healthcare, Medicaid, privacy, records management, audit, and regulatory requirements relevant to the organization's…