Enterprise Regulatory Compliance Audit & Monitoring Program Admin I

LTHC

. Evaluate new and evolving federal and state regulatory guidance and assess impacts on enterprise-wide business processes, products, and operational strategies .

Posted 10/26/2026full-timeRochester • New York • United StatesMid-LevelSenior💰 $65,346 - $117,622 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive knowledge of federal and state health care regulatory frameworks, compliance program operations, and the ability to translate complex regulatory guidance into practical solutions. Proven expertise in managing regulatory audits, stakeholder engagement, and developing compliance communications and training.

Highest-signal resume keywords

Regulatory Compliance ManagementHealth Insurance RegulationsProject CoordinationRegulatory Research and AnalysisStakeholder Engagement

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Regulatory ComplianceRisk AssessmentRegulatory ResearchCompliance Program OperationsUtilization ManagementClaims Processing WorkflowsAnalytical SkillsProject ManagementDocumentation PreparationRegulatory Audits

Soft Skills

Verbal CommunicationWritten CommunicationCreative Critical ThinkingAttention to DetailAccountability

Tools & Technologies

Microsoft OfficeEnterprise Systems

Certifications & Qualifications

CPCOCHCCHPCHCCA-related Credentials

Industry Keywords

MedicareMedicaidHealth Care DeliveryHealth Insurance IndustryRegulatory GuidanceCompliance SolutionsAccreditation AuditsCompliance KPIRegulatory Change InitiativesCross-Functional Collaboration

About the role

Key responsibilities & impact

Evaluate new and evolving federal and state regulatory guidance and assess impacts on enterprise-wide business processes, products, and operational strategies
Partner with functional business areas to translate complex regulatory guidance into practical, risk-based compliance solutions
Support administration of the enterprise regulatory compliance program
Monitor regulatory changes affecting the Health Plan and subsidiaries
Assess impacts to programs, procedures, policies, and systems supporting Medicare, Medicaid, Commercial, and retail market programs
Collaborate with Customer Service, Product and Operations, Marketing, Sales, Claims, Enrollment, Pharmacy, Quality Office, Utilization Management, and Advocacy teams
Gather evidence of compliance and support regulatory readiness and implementation
Identify compliance vulnerabilities, assist with root cause analysis, and support corrective actions and remediation plans
Support compliance KPI adherence, reporting, and remediation
Develop compliance communications, training, and monitoring activities
Attend business and project meetings to identify compliance considerations and mitigate regulatory risk
Participate in Compliance Oversight Committees
Prepare documentation, reports, and responses for regulatory filings, surveys, audits, and information requests
Support federal, state, and accreditation audits and examinations
At higher levels, coordinate cross-functional workgroups, lead regulatory change initiatives, represent the organization with external parties and regulators, oversee audits, advise senior leadership, and mentor team members

Requirements

What you’ll need

Level I: Seven or more years’ experience in health insurance or health care delivery, or bachelor’s degree in related area with four or more years of related experience
Working knowledge of federal and state health care regulatory frameworks affecting Medicare, Medicaid, and commercial products
Extensive knowledge of regulatory initiatives and legislation impacting the health insurance industry
Understanding of regulations and ability to administer compliance across an organization
Familiarity with utilization management, authorization, claims, and enrollment processing workflows and systems
Strong project coordination skills and ability to manage multiple priorities
Ability to conduct regulatory research, analyze guidance, and translate requirements into business-ready recommendations
Strong research, analytical, creative critical thinking, and risk assessment skills
Excellent verbal and written communication skills
High degree of accountability, follow-through, and attention to detail
Proficiency with Microsoft Office and enterprise systems
Level II: Nine or more years of relevant experience, or bachelor’s degree with six or more years of related experience
Advanced knowledge of health insurance regulations and compliance program operations
Experience managing multiple complex regulatory initiatives or compliance projects
Ability to exercise sound judgment and operate independently with minimal supervision
Strong stakeholder engagement and influence skills
Level III: Eleven or more years of relevant experience, or bachelor’s degree with eight or more years of related experience
Professional certification preferred, such as CPCO, CHC, CHPC, or HCCA-related credentials
Proven expertise resolving highly complex regulatory compliance issues and managing regulatory audits
Ability to operate with initiative, leadership, and strategic thinking
Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer
Ability to travel within the service region as needed
Regular and reliable attendance is required

Benefits

Comp & perks

Group health and/or dental insurance
Retirement plan
Wellness program
Paid time away from work
Paid holidays
Potential remote work, determined case-by-case
Opportunity to travel within the service region for meetings, audits, or trainings as needed