Data Integrity & Compliance Specialist

Pacific Health Group; Washington (District of Columbia); Remote; USD 33,000 - 37,000; Full time

Benefits offered by this job

PTO

Paid holidays

Volunteer hours

Bereavement leave

Health benefits

FSA

Disability insurance

EAP

401(k) match

Monthly stipend

Professional development

Employee discounts

In-person events

Job summary

Pacific Health Group is seeking a Data Administrator to maintain data integrity, support reporting, and ensure compliance across ECM, Medi-Cal, and other programs. You will compile data from multiple systems, manage authorizations, and provide leadership with actionable insights.

The role emphasizes collaboration with care teams, audits, and system migrations, with remote-friendly, full-time employment and competitive hourly pay.

Qualifications

• Bachelor’s degree in data management, healthcare administration, information systems, or related field (or equivalent experience).
• Experience in healthcare data administration, reporting, or compliance strongly preferred.
• Proficiency with CRM platforms, reporting dashboards, and data entry tools (TheraPlatform, SalesMate a plus).
• Strong analytical, organizational, and problem-solving skills.
• Ability to communicate clearly with executives, managers, and cross-functional teams.
• Preferred: Familiarity with Medi-Cal, ECM, CalAIM, and health plan compliance processes.

Responsibilities

• Oversee the monthly and quarterly submission of ECM Report Template Files (RTF) and Outreach Transmission Files (OTF) to all contracted health plans.
• Gather, validate, and consolidate data from multiple internal systems, ensuring accuracy of member demographics, service dates, and case notes.
• Ensure all submissions meet health plan-specific formatting and regulatory requirements to maintain compliance.
• Monitor submission timelines, confirm receipt with health plans, and troubleshoot errors or rejections quickly to avoid penalties.
• Conduct recurring eligibility checks to confirm members remain qualified for ECM, Medi-Cal, and other service programs.
• Partner with case managers to reassess member needs and adjust service enrollments accordingly.
• Document all re-qualification activities in compliance with audit standards and payer expectations.
• Update member statuses promptly to ensure accurate resource allocation and continuity of care.
• Manage the end-to-end process for obtaining initial authorizations and subsequest reauthorizations through various provider portals.
• Track the status of all authorizations, maintaining detailed records of approvals, denials, and pending renewals.
• Maintain a consolidated and reliable view of all member touchpoints by duplicating Lead Care Manager (LCM) notes from TheraPlatform into SalesMate.
• Standardize note formatting and apply appropriate tags or categories for efficient retrieval and reporting.
• Perform regular audits to identify missing or incomplete data entries and resolve discrepancies with care teams.
• Ensure that data captured across platforms supports continuity of care and enhances leadership visibility.
• Compile weekly updates on member statuses, including active, pending, and closed cases, and distribute to executive and leadership teams.
• Track and highlight trends such as outreach completion rates, reassessment activity, and engagement levels.
• Translate raw data into actionable insights that enable leadership to make timely, data-driven decisions.
• Deliver clear reports to multiple stakeholders, including department heads, sales teams, and executive leadership.
• Review and update member profiles regularly to ensure active/inactive statuses are correct and align with real-time service delivery.
• Confirm discharge reasons, service end dates, and member transitions are fully documented for compliance.
• Flag discrepancies proactively and work directly with care teams to resolve errors.
• Maintain health plan compliance standards by ensuring member record integrity and audit readiness.
• Produce recurring weekly and monthly reports to monitor organizational performance and compliance.
• Track key indicators such as member counts, service utilization, eligibility changes, and program engagement rates.
• Provide tailored progress reports to leadership or external partners to demonstrate accountability.
• Support internal audits and quality improvement initiatives by providing clear, accurate, and timely data.
• Aggregate demographic, economic, and healthcare utilization data to identify new regions for community-based program expansion.
• Conduct in-depth research on local regulations, health plan coverage, and community needs to ensure successful placement.
• Build and maintain structured databases of potential partners, community events, and opportunities for organizational outreach.
• Validate data sources for accuracy and reliability to support leadership in making informed, evidence-based decisions.
• Research and curate a calendar of community events, conferences, and networking opportunities aligned with organizational goals.
• Assess the strategic value of events based on target populations, potential partnerships, and visibility opportunities.
• Partner with internal teams to coordinate event participation, including logistics, staffing, and materials.
• Track outcomes and engagement metrics post-event to evaluate return on investment and guide future planning.
• Support evolving priorities by assisting with data system implementations, migrations, and workflow redesigns.
• Participate in special projects such as large-scale data audits or compliance-focused reviews.
• Help onboard and train new staff in data procedures, system use, and reporting protocols.
• Work cross-functionally with IT to troubleshoot system issues and optimize workflows.

Job description

Pacific Health Group is seeking a Data Administrator to maintain data integrity, support reporting, and ensure compliance across ECM, Medi-Cal, and other programs. You will compile data from multiple systems, manage authorizations, and provide leadership with actionable insights.

The role emphasizes collaboration with care teams, audits, and system migrations, with remote-friendly, full-time employment and competitive hourly pay.