Financial and Regulatory Analyst

100% Remote Full-time Open now

About the position Find your purpose as a Financial and Regulatory Analyst at CentraCare. The Financial and Regulatory Policy Analyst serves as a cross-functional expert supporting financial analysis, payer policy review, and regulatory compliance. This role is responsible for evaluating the financial and operational impact of payer policies, government reimbursement regulations, and healthcare legislation. The analyst partners with managed care, revenue cycle, government reimbursement, compliance, and clinical operations teams to ensure alignment with payer requirements, optimize reimbursement, and mitigate regulatory risk. Schedule: Full-time 72 hours every 2 weeks Hours between Monday - Friday 8:00a-5:00p CST Fully remote Pay and Benefits: Starting pay begins at $63,747.33 per year and increases with experience. Salary range: $63,747.33-$95,642.90 per year Salary range is based on a 1.0 FTE, reduced FTE will result in a prorated offer rate We offer a generous benefits package that includes medical, dental, flexible spending accounts, PTO, 401(k) retirement plan & match, LTD and STD, tuition reimbursement, discounts at local and national businesses and so much more! Qualifications: Bachelor’s degree in Finance, Health Administration, Public Health, Economics, or related field or 5+ years of experience in financial analysis, strong report-building skills, payer relations, or regulatory affairs in a healthcare environment. Understanding of Medicare and Medicaid payment systems, managed care contracts, and payer policies required. Proficiency in Excel and financial modeling; ability to interpret large datasets required. Familiarity with EHR and revenue systems (e.g., Epic, Lawson, Strata, or similar) preferred. Experience with payer audits, prior authorization processes, and coverage policy review preferred. Strong analytical, report creation, and critical thinking skills. Clear written and verbal communication. Regulatory and policy acumen. Detail orientation with the ability to synthesize complex information. Collaboration and stakeholder engagement Core Functions: Payer Policy & Regulatory Intelligence Monitor and interpret payer policy updates, government reimbursement rules (e.g., Medicare, Medicaid, commercial plans), and legislation impacting financial performance. Analyze changes in payer coverage determinations, billing guidelines, and authorization policies to assess impact on access, documentation, and reimbursement. Collaborate with internal stakeholders to implement payer policy changes and ensure compliance across the revenue cycle and clinical departments. Identify opportunities for revenue enhancement and cost reduction through proactive management of payer policies. Financial Analysis & Forecasting Build and maintain financial models to forecast the revenue impact of regulatory or payer policy changes. Analyze variances in net revenue, denials, and reimbursement trends related to policy shifts and provide regular reports to the HealthCare Affordability Committee. Support budget planning and value-based contract modeling by incorporating regulatory and policy data. Develop metrics to track policy compliance, identify gaps, and propose solutions to improve processes and outcomes. Document and communicate findings, recommendations, and action plans to the HealthCare Affordability Committee. Regulatory Compliance & Reporting Track regulatory requirements from CMS, state Medicaid agencies, and commercial payers. Collaborate with compliance teams and revenue integrity teams to implement and maintain internal controls and audits to minimize risk. Collaborate with payer relations to address any payer-policy-related issues. Monitor adherence to payer policies across the organization. Partner with clinical and operational teams to ensure policy changes are implemented efficiently and effectively. Collaborate with the legal department to review and interpret contracts, agreements, and regulations. Communicate effectively with payers to clarify policy details and resolve disputes. Work closely with the revenue cycle management team to optimize claims processing and reimbursement. Cross-Functional Collaboration Act as a liaison between Finance, Compliance, Managed Care, Revenue Cycle, and Clinical Operations teams. Analyze clinical vendor reimbursement assumptions. Deliver policy summaries and financial impact briefs to operational leaders, with clear recommendations. Support stakeholders on new or updated payer policies and regulatory requirements. CentraCare has made a commitment to diversity in its workforce and all individuals, including, but not limited to, individuals with disabilities, are encouraged to apply. CentraCare is an EEO/AA employer.

Responsibilities

Payer Policy & Regulatory Intelligence Monitor and interpret payer policy updates, government reimbursement rules (e.g., Medicare, Medicaid, commercial plans), and legislation impacting financial performance.
Analyze changes in payer coverage determinations, billing guidelines, and authorization policies to assess impact on access, documentation, and reimbursement.
Collaborate with internal stakeholders to implement payer policy changes and ensure compliance across the revenue cycle and clinical departments.
Identify opportunities for revenue enhancement and cost reduction through proactive management of payer policies.
Financial Analysis & Forecasting Build and maintain financial models to forecast the revenue impact of regulatory or payer policy changes.
Analyze variances in net revenue, denials, and reimbursement trends related to policy shifts and provide regular reports to the HealthCare Affordability Committee.
Support budget planning and value-based contract modeling by incorporating regulatory and policy data.
Develop metrics to track policy compliance, identify gaps, and propose solutions to improve processes and outcomes.
Document and communicate findings, recommendations, and action plans to the HealthCare Affordability Committee.
Regulatory Compliance & Reporting Track regulatory requirements from CMS, state Medicaid agencies, and commercial payers.
Collaborate with compliance teams and revenue integrity teams to implement and maintain internal controls and audits to minimize risk.
Collaborate with payer relations to address any payer-policy-related issues.
Monitor adherence to payer policies across the organization.
Partner with clinical and operational teams to ensure policy changes are implemented efficiently and effectively.
Collaborate with the legal department to review and interpret contracts, agreements, and regulations.
Communicate effectively with payers to clarify policy details and resolve disputes.
Work closely with the revenue cycle management team to optimize claims processing and reimbursement.
Cross-Functional Collaboration Act as a liaison between Finance, Compliance, Managed Care, Revenue Cycle, and Clinical Operations teams.
Analyze clinical vendor reimbursement assumptions.
Deliver policy summaries and financial impact briefs to operational leaders, with clear recommendations.
Support stakeholders on new or updated payer policies and regulatory requirements.

Requirements

Bachelor’s degree in Finance, Health Administration, Public Health, Economics, or related field or 5+ years of experience in financial analysis, strong report-building skills, payer relations, or regulatory affairs in a healthcare environment.
Understanding of Medicare and Medicaid payment systems, managed care contracts, and payer policies required.
Proficiency in Excel and financial modeling; ability to interpret large datasets required.
Strong analytical, report creation, and critical thinking skills.
Clear written and verbal communication.
Regulatory and policy acumen.
Detail orientation with the ability to synthesize complex information.
Collaboration and stakeholder engagement

Nice-to-haves

Familiarity with EHR and revenue systems (e.g., Epic, Lawson, Strata, or similar) preferred.
Experience with payer audits, prior authorization processes, and coverage policy review preferred.