Regulatory Affairs Consultant - Remote

Regulatory Affairs Consultant

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives?

Join us to start Caring. Connecting. Growing together.

The Regulatory Affairs Consultant is responsible for monitoring, analyzing, and interpreting federal and state healthcare reimbursement regulations to ensure compliance across assigned products and services. This role interprets complex and evolving regulatory guidance, conducts impact assessments, and converts regulatory requirements into actionable business rules used to develop product specifications and operational workflows that ensure compliance and accurate implementation. Working closely with Product Managers, Business Analysts, and technical teams, the consultant supports the implementation of regulatory changes within the EASYGroup™ Prospective Payment System (PPS) product suite and contributes to ongoing product enhancements aligned with reimbursement trends and industry developments.

You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

• Monitor and analyze federal and state regulatory updates impacting healthcare reimbursement
• Interpret complex regulatory requirements and assess impacts to products, services, and client solutions
• Research and resolve unclear, conflicting, or evolving regulatory guidance
• Translate regulatory requirements into business rules that will be used to create operational workflows, and product specifications
• Develop regulatory summaries, impact analyses, and implementation recommendations
• Serve as a Subject Matter Expert (SME) for assigned areas of the EASYGroup™ PPS software suite
• Support regulatory updates, product enhancements, and software releases to maintain compliance
• Perform User Acceptance Testing (UAT), develop test scenarios, and validate functionality and regulatory compliance
• Maintain regulatory content within internal systems, databases, and client-facing platforms
• Manage and update tools utilized for regulatory monitoring and data collection
• Respond to client inquiries through Salesforce, email, meetings, and other communication channels
• Communicate regulatory and product updates through written documentation, webinars, and client discussions
• Collaborate with cross-functional teams to ensure timely resolution of client and product-related questions
• Research Medicare, Medicaid, TRICARE, commercial payer reimbursement methodologies, and emerging payment models
• Evaluate state-specific reimbursement systems, healthcare trends, and market opportunities
• Identify and implement process improvements to enhance efficiency, accuracy, and the overall client experience

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• 3+ years of experience in healthcare reimbursement, regulatory analysis, healthcare policy, or a related discipline
• 2+ years of experience with Medicare, Medicaid, and other healthcare reimbursement methodologies
• 2+ years of experience with analytics, research, and problem-solving

Preferred Qualifications:

• Experience interpreting regulatory guidance and translating requirements into operational or technical solutions
• Ability to manage multiple priorities and work independently in a dynamic environment
• Excellent written and verbal communication skills with the ability to convey complex information to technical and non-technical audiences
• PPS methodologies, CMS regulations, state Medicaid programs, healthcare software products, Salesforce,…