Healthcare Regulatory Strategy & Operations (JD preferred)

Stedi Healthcare Regulatory Specialist

We're looking for someone with a deep understanding of the HIPAA standard transactions as defined in 45 CFR Part 162 and their application to the healthcare clearinghouse regulatory environment. This person should have a strong mix of regulatory, legal, and product knowledge and the stamina to relentlessly apply that knowledge to help us scale our network of payer connections.

You will work closely with our Payer Strategy & Operations team who are establishing relationships with payers and, if necessary, their designated intermediaries such as clearinghouses and MACs. Some groups will connect readily, while others will require persistent follow-ups or will need help remediating their non-compliant requirements (for example, when their connection processes violate HIPAA, X12, or CAQH CORE rules).

Your primary responsibility is to help move these groups from a "no" to "yes," both by working directly with these groups as well as with regulatory or standards bodies such as CMS, CAQH CORE, X12, and more.

This isn't traditional legal work it's regulatory strategy paired with operational execution. Your job is to absorb relevant regulations, build the playbook, and run campaigns that expand our payer network in big ways.

In addition to our Payer Strategy & Ops team, you will work with our CEO, Head of Legal, and General Manager to remove bottlenecks and use your regulatory knowledge to help shape our product strategy and roadmap.

If you're excited about tackling the hardest problems in healthcare infrastructure, using regulatory depth to unlock growth, and delivering game-changing impact at a fast-moving company, you'll thrive here.

Responsibilities

• Build and maintain a commanding knowledge of CAQH CORE operating rules, 45 CFR Part 162 transaction standards, CMS guidance letters, and related materials to build Stedi's regulatory fact base that will inform our payer connectivity and product surface area.
• Partner with Legal, Operations, and Executive teams to interpret federal and state-level guidance and translate it into actionable strategies that remove blockers to connectivity.
• Identify, analyze, and resolve payer-side regulatory challenges including nonconformance, exclusivity agreements, and data submission policies to accelerate network growth.
• Draft outreach citing specific, relevant regulation that compels action while maintaining excellent relationships with payers and a stellar reputation in the industry.
• Work directly with world-class external counsel when necessary, while recognizing that over 95% of situations should be resolved without outside help.
• Maintain a system of record for payer communication, regulatory milestones, and escalations ensuring consistency, traceability, and accountability.
• Represent Stedi in discussions with payers, clearinghouses, and regulators, and continue to establish Stedi as a trusted, compliant, and forward-thinking network partner.

Qualifications

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We appreciate your attention to this and your interest in joining Stedi.

At Stedi, we're looking for people who are deeply curious and aligned to our ways of working. You're encouraged to apply even if your experience doesn't perfectly match the job description.