Regulatory Review Specialist, RN
Location
Texas
Posted
10 days ago
Salary
0
Seniority
Senior
Job Description
Regulatory Review Specialist, RN
VitalCaring Group
• Support payer audits and medical record reviews, ensuring timely and accurate submission of requested documentation • Manage medical review requests and appeals associated with CMS contractors, regulatory agencies, and billing intermediaries • Review clinical documentation using established audit and submission checklists • Partner with operational and clinical teams to gather and validate required records • Participate in chart reviews and compliance monitoring initiatives across the organization • Assist with risk identification activities and regulatory readiness efforts • Support investigations and corrective actions related to compliance findings • Maintain audit tracking and outcomes through documentation systems and reporting tools • Navigate multiple EMRs, payer portals, and operational systems to manage submissions and appeals • Contribute to training and educational materials that strengthen compliance knowledge across teams • Participate in internal quality, billing, and operational review activities • Complete additional regulatory and administrative projects as assigned
Job Requirements
- Current Registered Nurse (RN) license
- Minimum 3 years of clinical operational leadership or supervision experience within Home Health and/or Hospice
- Strong knowledge of CMS Home Health regulations and state/federal licensing standards
- Experience performing clinical chart reviews and documentation audits
- Ability to independently prioritize and manage work in a remote environment
- Strong technical skills and comfort navigating multiple systems and portals
- Excellent communication, organization, and follow-through.
- Preferred Experience: Medical review, appeals, audit response, or utilization review experience
- Exposure to payer audits and contractor review processes
- Experience supporting compliance, quality, accreditation, or regulatory initiatives
- Experience with EMR platforms and documentation tracking systems
- Background working with billing, reimbursement, or operational compliance functions
Benefits
- Medical, Dental, and Vision coverage
- Pharmacy benefits
- Virtual care and mental health support
- Flexible Spending Accounts (FSA) and Health Savings Account (HSA)
- Supplemental health and life insurance
- 401(k) with company match
- Employee referral program
- Prepaid legal services
- Identity theft protection
- Generous paid time off
- Pet insurance
- Tuition and continuing education reimbursement
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