Remote Healthcare Data & Compliance Analyst

Pacific Health Group; Nevada; Remoto; USD 33.000 - 37.000; Tempo pieno

Vantaggi offerti da questo lavoro

90% Employer-paid Medical Benefits

Flexible Spending Account (FSA)

Disability | AD&D

Employee Assistance Program (EAP)

Bereavement Leave

Descrizione del lavoro

Pacific Health Group is seeking a data-focused professional to manage ECM/OTF submissions, validate multi-system data, and ensure regulatory compliance. You will generate reports, analyze trends, and support leadership with timely insights.

You will collaborate with IT and care teams, participate in system improvements, and help expand community outreach through accurate data handling.

Competenze

• 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).
• Preferred: Familiarity with Medi-Cal, ECM, CalAIM, and health plan compliance processes.
• 12 Paid Holidays per year, including your birthday and one floating holiday after 1 year of employment.

Mansioni

• Oversee the monthly and quarterly submission of Enhanced Care Management (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.
• Document all re-qualification activities in compliance with audit standards and payer expectations.
• Perform regular audits to identify missing or incomplete data entries and resolve discrepancies with care teams.
• Translate raw data into actionable insights that enable leadership to make timely, data-driven decisions.
• Produce recurring weekly and monthly reports to monitor organizational performance and compliance.
• 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.

Conoscenze

Data management

Data reporting

Regulatory compliance

Cross-functional collaboration

Formazione

Bachelor degree in data management or related field

Strumenti

TheraPlatform

SalesMate

Descrizione del lavoro

Pacific Health Group is seeking a data-focused professional to manage ECM/OTF submissions, validate multi-system data, and ensure regulatory compliance. You will generate reports, analyze trends, and support leadership with timely insights.

You will collaborate with IT and care teams, participate in system improvements, and help expand community outreach through accurate data handling.