Vālenz® Health is the platform to simplify healthcare – the destination for employers, payers, providers and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey – from care navigation and management to payment integrity, plan performance and provider verification. With a 99% client retention rate, we elevate expectations to a new level of efficiency, effectiveness and transparency where smarter, better, faster healthcare is possible.
About This Opportunity:
As a Sr. Product Compliance Specialist - Payment Integrity, you'll support Payment Integrity and Payment Operations as the primary compliance lead for regulatory requirements impacting claims, billing, reimbursement, and payment activities. You'll provide risk-based compliance oversight for areas including the No Surprises Act (NSA), Fraud, Waste & Abuse (FWA), regulatory change management, operational initiatives, and other payment-related processes.
You'll partner closely with Product, Operations, and Corporate Compliance teams to support policy governance, compliance training, issue intake management, and ongoing efforts to ensure compliance with applicable state and federal regulations.
Things You’ll Do Here:
- Serve as the primary compliance liaison for Payment Integrity and Payment Operations, providing strategic guidance on regulatory and operational compliance matters.
- Interpret, analyze, and operationalize applicable regulatory requirements, including the No Surprises Act (NSA), Fraud, Waste & Abuse (FWA) laws, CMS requirements, and state Department of Insurance (DOI) regulations impacting payment and billing practices.
- Provide compliance oversight and guidance related to payment workflows, reimbursement methodologies, claims administration processes, and product development initiatives.
- Partner cross-functionally with operational leaders to identify, assess, and mitigate financial and regulatory compliance risks associated with payment and claims functions.
- Monitor and evaluate emerging regulatory developments, enforcement trends, and industry guidance to determine operational impact and support implementation of required changes.
- Support the development, review, implementation, and maintenance of financial and payment-related policies, procedures, and standard operating procedures (SOPs).
- Participate in high-risk initiatives, system implementations, process enhancements, and product changes to ensure compliance considerations are appropriately addressed.
- Assist with incident response activities involving payment disputes, FWA-related escalations, regulatory inquiries, and other compliance-related matters.
- Support internal audits, external audits, client audits, and regulatory examinations by coordinating documentation, responding to inquiries, and ensuring audit readiness.
- Collaborate with Corporate Compliance and cross-functional stakeholders on issue intake, triage, investigation support, tracking, corrective action planning, and resolution activities.
- Develop and deliver training, education, and compliance guidance to internal stakeholders regarding applicable regulatory requirements, policies, and operational expectations.
- Maintain accurate and organized documentation supporting compliance oversight activities, monitoring efforts, investigations, and audit preparedness.
What You’ll Bring to the Team:
- Bachelor’s degree required; concentration in Healthcare Administration, Finance, Business Administration, or a related field preferred.
- 5+ years of progressive experience in healthcare compliance, payment integrity, regulatory compliance, or related healthcare operations.
- Certified Professional Coder (CPC) credential or equivalent coding certification.
- Demonstrated knowledge and experience with claims processing operations and/or payment integrity programs.
- Demonstrated knowledge of healthcare billing, coding, and reimbursement regulations.
- Demonstrated experience with Fraud, Waste & Abuse (FWA) compliance frameworks and investigative processes
A plus if you have…
- Experience supporting No Surprises Act (NSA) implementation, oversight, and compliance activities.
- Experience within Payment Integrity, health plan, payer-side, or managed care operations.
- Familiarity with CMS programs, regulatory requirements, and enforcement priorities impacting claims and payment oversight.
- Experience operating within a Business Associate environment and supporting HIPAA-related compliance obligations.
- Professional certifications such as Certified in Healthcare Compliance (CHC), Certified Fraud Examiner (CFE), CPC, or other relevant healthcare compliance credentials.
Where You’ll Work: This is a fully remote position, and we’ll provide all the necessary equipment!
- Work Environment: You’ll need a quiet workspace that is free from distractions.
- Technology: Reliable internet connection—if you can use streaming services, you’re good to go!
- Security: Adherence to company security protocols, including the use of VPNs, secure passwords, and company-approved devices/software.
- Location: You must be US based, in a location where you can work effectively and comply with company policies such as HIPAA.
Why You'll Love Working Here
Valenz is proud to be recognized by Inc. 5000 as one of America’s fastest-growing private companies. Our team is committed to delivering on our promise to engage early and often for smarter, better, faster healthcare. With this commitment, you’ll find an engaged culture – one that stands strong, vigorous, and healthy in all we do.
Benefits
- Generously subsidized company-sponsored Medical, Dental, and Vision insurance, with access to services through our own products, Healthcare Blue Book and KISx Card.
- Spending account options: HSA, FSA, and DCFSA
- 401K with company match and immediate vesting
- Flexible working environment
- Generous Paid Time Off to include vacation, sick leave, and paid holidays
- Employee Assistance Program that includes professional counseling, referrals, and additional services
- Paid maternity and paternity leave
- Pet insurance
- Employee discounts on phone plans, car rentals and computers
- Community giveback opportunities, including paid time off for philanthropic endeavors
Skills Required
- Bachelor's degree
- 5+ years progressive experience in healthcare compliance, payment integrity, regulatory compliance, or related healthcare operations
- Certified Professional Coder (CPC) credential or equivalent coding certification
- Knowledge and experience with claims processing operations and/or payment integrity programs
- Knowledge of healthcare billing, coding, and reimbursement regulations
- Experience with Fraud, Waste & Abuse (FWA) compliance frameworks and investigative processes
- Ability to work remotely from the U.S. with reliable internet and adhere to company security protocols (VPN, secure passwords, company-approved devices/software)
- Experience supporting No Surprises Act (NSA) implementation, oversight, and compliance activities
- Experience within Payment Integrity, health plan, payer-side, or managed care operations
- Familiarity with CMS programs, regulatory requirements, and enforcement priorities
- Experience operating within a Business Associate environment and supporting HIPAA-related compliance obligations
- Professional certifications such as Certified in Healthcare Compliance (CHC), Certified Fraud Examiner (CFE), Certified Professional in Healthcare Quality (CPHQ)
- Clinical background such as Registered Nurse (RN) or equivalent clinical experience (for Care Management compliance variant)
Vālenz Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Vālenz Health and has not been reviewed or approved by Vālenz Health.
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Healthcare Strength — Health coverage includes broad options and special programs like no‑cost diagnostic imaging and outpatient procedures, strengthening perceived healthcare value. Employer subsidies and access to navigation tools are emphasized to support cost‑effective care.
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Retirement Support — A 401(k) with company match and immediate vesting is offered, supporting long‑term savings and financial security. This structure can increase the attractiveness of total rewards.
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Parental & Family Support — Paid leave for new family members and supportive family benefits are highlighted, signaling attention to life‑stage needs. These provisions complement broader work‑life policies and can enhance retention.
Vālenz Health Insights
What We Do
Vālenz® Health is the platform to simplify healthcare – the destination for employers, payers, providers and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey – from care navigation and management to payment integrity, plan performance and provider verification. With a 99% client retention rate, we elevate expectations to a new level of efficiency, effectiveness and transparency where smarter, better, faster healthcare is possible. For more information, visit valenzhealth.com
