Manager, Regulatory & Payer Operations Support

Job Function Summary
The Manager, Regulatory & Payer Operations Support provides leadership and oversight for the Regulatory & Payer Operations Specialist team. The role ensures regulatory readiness, payer operations excellence, audit support, authorization and eligibility support functions, compliance adherence, and operational consistency across supported locations.

Major Areas of Accountability

• Lead, coach, and develop Regulatory & Payer Operations Specialists.
• In coordination with other teams, will ensure proper staffing at all office locations and will ensure that offices are staffed during periods of PTO and staff development.
• Manage staffing, performance evaluations, training, and workforce planning.
• Working with the Manager, Payer Credentialing, will manage ensure office survey readiness and compliance with CMS, Medicaid, accreditation, licensing, and company requirements.
• Monitor regulatory and payer changes and coordinate implementation activities.
• Oversee insurance verification, benefits investigation, and prior authorization support processes of direct reports.
• Escalate and resolve complex payer, eligibility, authorization, and reimbursement issues.
• Direct team in support of audit response coordination and medical record retrieval efforts.
• Develop operational metrics, reporting, and performance dashboards.
• Partner with Revenue Cycle, Compliance, Operations, Credentialing, and Payer Relations leadership.
• Identify and communicate process improvement opportunities.
• Comfort Medical employees are required to conduct business to the highest ethical and professional standards; comply with applicable laws and regulations, the MedTech Code of Conduct, and company policies.
• Where applicable, will function as Pharmacist-In-Charge.
• May be required to obtain additional licenses as required.
• Other job duties as assigned.

Basic Qualifications

• Must have minimally completed a bachelor's degree in pharmacy and currently hold the designation of RPh
• Must hold an active pharmacist license in Florida
• Minimum 5 years of experience in healthcare reimbursement, payer operations, regulatory affairs, compliance, revenue cycle, or healthcare operations.
• Minimum 2 years of leadership experience.
• Experience managing audits, compliance programs, or payer operations functions.
• Knowledge of Medicare, Medicaid, and commercial payer processes.
• Strong communication, analytical, organizational, and project management skills.
• Proficiency in Microsoft Office applications.

Preferred Qualifications

• Experience in DMEPOS, HME, home health, or other regulated healthcare environments.

Comfort Medical provides an extensive selection of name brand catheter and ostomy supplies to thousands of customers nationwide. Our attention to detail, unmatched customer service, and dedication to helping our customers live happier, healthier lives are just a few of the many reasons we are one of the fastest growing catheter and ostomy supply companies in the nation!

Comfort Medical employees are required to conduct business to the highest ethical and professional standards; comply with applicable laws and regulations, the Advamed Code of Ethics on Interactions with Healthcare Professionals, and company policies.

Comfort Medical is committed to a policy of Equal Employment Opportunity (EEO) which means we employ and promote individuals based on their merits, regardless of race, color, religion, sex, national origin, age, disability, veteran status, pregnancy, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status, status with regards to public assistance or any other protected classification.

61820
#LI-CM #LI-HYBRID