Compliance & Data Analyst

Essen Medical Associates; New York (NY); In loco; USD 66.000 - 70.000; Tempo pieno

Descrizione del lavoro

NYREACH – New York Research, Education & Community Health, Inc. is seeking a Compliance and Operational Analytics professional for the Social Care Network in NY.

You will ensure eligibility assessments are completed within seven days of referral, track timeliness metrics, and maintain audit-ready evidence across standard workflows. The role requires a Bachelor's degree (Master’s preferred), strong knowledge of audit processes, advanced Excel skills, and experience with 1115 Waiver programs.

Competenze

• Bachelor’s degree required; Master’s degree in public health, health administration or related field preferred.
• Strong understanding of audit processes and documentation standards.
• Advanced analytical, reporting and organizational skills.
• Ability to collaborate with Navigators, Program Leads, Directors and external partners.
• Advanced Microsoft Excel skills.
• Experience with 1115 Waiver programs, Social Care Networks, Medicaid or managed care compliance preferred.
• Experience supporting internal or external audits in healthcare or social services.

Mansioni

• Ensure eligibility assessments completed within seven days of referral receipt.
• Track timeliness metrics and maintain audit-ready evidence.
• Escalate delays to Program Leads and Directors.
• Build and maintain standard workflows for timely determinations.
• Monitor referrals to ensure closed-loop completion per standards.
• Perform compliance follow-ups on aging referrals.
• Verify outcomes are documented in member records.
• Flag unresolved referrals presenting compliance risk.

Conoscenze

Analytical thinking

Attention to detail

Documentation accuracy

Collaboration

Formazione

Bachelor’s degree

Master’s degree preferred

Strumenti

Microsoft Excel

Microsoft Teams

Microsoft Outlook

Microsoft Word

Microsoft PowerPoint

Descrizione del lavoro

Compliance and operational analytics for NYREACH’s Social Care Network (SCN) under New York State’s 1115 Waiver.

Responsibilities

• Ensure eligibility assessments are completed within seven (7) calendar days of referral receipt, aligned with SCN and 1115 Waiver requirements
• Track timeliness metrics and maintain audit-ready evidence showing assessment completion
• Escalate delays or barriers to Program Leads and Directors
• Build and maintain standard workflows that support timely eligibility determinations
• Monitor internal and external referrals to ensure closed-loop completion per PHS and SOMOS audit standards
• Perform compliance follow-ups on open or aging referrals
• Verify referral outcomes are documented clearly and accurately in member records
• Flag and unresolved referrals that present compliance risk
• Review member profiles and navigation records to identify missing or open navigation activities tied to billing opportunities
• Maintain navigation trackers to ensure no eligible service or reimbursement opportunity is missed
• Validate navigation activities are supported by appropriate documentation and eligibility criteria
• Partner with Navigators to resolve documentation gaps prior to billing or reporting
• Ensure notes, eligibility documentation, and care plans meet SCN documentation and audit standards
• Confirm care plans are updated based on screenings, referrals, and changes in member needs
• Enforce internal documentation standards aligned with PHS, SOMOS, and NYS DOH guidance
• Conduct routine audits of a minimum of 10% of enhanced-level members
• Validate enhanced members are connected to required referrals and services
• Document audit findings, corrective actions, and resolution timelines
• Maintain audit logs and supporting evidence for internal and external review
• Review all Client Action items, including internal and external referrals
• Coordinate with Navigators to obtain required responses and documentation
• Decline or return referrals that lack sufficient documentation or eligibility support
• Track and report closure and resolution status of all Client Action items
• Create, document, and maintain operating procedures and compliance policies for SCN workflows
• Ensure processes remain aligned with evolving 1115 Waiver, SCN, PHS, and SOMOS guidance
• Communicate compliance expectations and policy updates to Navigators and leadership
• Serve as an internal subject matter expert on SCN compliance requirements
• Produce routine compliance, productivity, and audit-readiness reports
• Monitor key indicators related to eligibility timeliness, referral closure, documentation quality, and billing readiness
• Analyze trends and identify operational or compliance risks; present findings and recommendations to Directors and executive leadership
• Lead SCN-related audits conducted by PHS, SOMOS, and other oversight entities
• Coordinate audit preparation, data validation, and documentation submission
• Support Directors in audit response strategy, corrective action plans, and follow-up reporting
• Maintain continuous audit readiness across all SCN program activities

Requirements

• Bachelor’s degree required; Master’s degree in public health, health administration, social work, or related field preferred
• Strong understanding of audit processes, documentation standards, and compliance monitoring
• Advanced analytical, reporting, and organizational skills
• Ability to collaborate with Navigators, Program Leads, Directors, and external partners
• Strong attention to detail and documentation accuracy
• Advanced Microsoft Excel skills
• Proficiency in Teams, Outlook, Word, and PowerPoint
• Experience with 1115 Waiver programs, Social Care Networks, Medicaid, or managed care compliance strongly preferred
• Experience supporting internal or external audits in a healthcare or social services setting

Technologies

• Microsoft Excel
• Microsoft Teams
• Microsoft Outlook
• Microsoft Word
• Microsoft PowerPoint

Key Performance Targets

• Eligibility assessments completed within 7 days: 95% (PHS/SOMOS timeliness standard)
• Closed-loop referral completion rate: 90% with documented outcomes
• Navigation activities supported by compliant documentation: 95%
• Care plans updated and compliant: 95%
• Enhanced-level members connected to required referrals: 100%
• Audit sample completion and issue resolution within required timeframes: 100%
• Zero material audit findings related to missing documentation or unsupported billing

Location & Compensation

• Location: Bronx, NY (onsite)
• Salary: USD 66,300 - 70,000 per year

Equal Opportunity Employer: NYREACH – New York Research, Education & Community Health, Inc., 2021 Grand Concourse, Bronx, NY 10453