Compliance & Data Analyst, NYREACH

Essen Medical Associates•Bronx, NY

About The Position

NYREACH is a Bronx-based nonprofit focused on addressing health disparities through community-driven solutions. It connects people to healthcare and essential social services while building partnerships across New York City. The Compliance & Data Analyst provides oversight, quality assurance, and audit readiness for NYREACH’s Social Care Network (SCN) activities under New York State’s 1115 Waiver. The role ensures that screenings, eligibility determinations, navigation activities, referrals, and documentation meet program requirements, PHS and SOMOS audit standards, and contractual compliance expectations. The Analyst serves as both a compliance lead and operational analyst, creating and maintaining procedures and policies, monitoring day-to-day compliance, auditing data for accuracy, and working with Navigators, Program Leads, and Directors to ensure consistent compliance, accuracy, and audit readiness. The role also leads SCN-related audits conducted by PHS, SOMOS, and other oversight entities, coordinating preparation, data validation, documentation submission, audit responses, corrective action plans, and follow-up reporting.

Requirements

Bachelor’s degree required.
Strong understanding of audit processes, documentation standards, and compliance monitoring.
Advanced analytical, reporting, and organizational skills.
Ability to work collaboratively with Navigators, Program Leads, Directors, and external partners.
Strong attention to detail and documentation accuracy.
Advanced Microsoft Excel skills.
Proficiency in Microsoft Teams, Outlook, Word, and PowerPoint.

Nice To Haves

Master’s degree in public health, health administration, social work, or a related field.
Experience with 1115 Waiver programs, Social Care Networks, Medicaid, or managed care compliance.
Experience supporting internal or external audits in a healthcare or social services setting.

Responsibilities

Ensure eligibility assessments are completed within seven calendar days of referral receipt; track timeliness, maintain audit-ready evidence, escalate delays, and develop workflows for timely determinations.
Monitor internal and external referrals for closed-loop completion; follow up on open or aging referrals, verify documented outcomes, and escalate unresolved compliance risks.
Review member profiles and navigation records for missing or open activities tied to billing opportunities; maintain navigation trackers, validate documentation and eligibility criteria, and work with Navigators to resolve gaps before billing or reporting.
Ensure notes, eligibility documentation, and care plans meet SCN documentation and audit standards; confirm care plans reflect screenings, referrals, and changes in member needs; enforce standards aligned with PHS, SOMOS, and NYS DOH guidance.
Audit a minimum of ten percent of enhanced-level members; verify connections to required referrals and services; document findings, corrective actions, and resolution timelines; maintain audit logs and supporting evidence.
Review all Client Action items, including internal and external referrals; coordinate with Navigators to obtain responses and documentation; decline or return inadequately supported referrals; track and report closure and resolution status.
Create, document, and maintain operating procedures and compliance policies for SCN workflows; keep processes aligned with evolving 1115 Waiver, SCN, PHS, and SOMOS guidance; communicate requirements and updates; serve as an internal SCN compliance subject matter expert.
Produce routine compliance, productivity, and audit-readiness reports; monitor eligibility timeliness, referral closure, documentation quality, and billing readiness; analyze trends and 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 audit response strategies, corrective action plans, and follow-up reporting; maintain continuous audit readiness.
Work toward stated performance targets: at least 95% of eligibility assessments completed within seven days; at least 90% closed-loop referral completion with documented outcomes; at least 95% compliant navigation documentation and care plans; 100% of enhanced-level members connected to required referrals; 100% completion of audit samples and issue resolution within required timeframes; and zero material findings related to missing documentation or unsupported billing.