Compliance Data Analyst

Essen Medical Associates•Bronx, NY

About The Position

NYREACH is a Bronx-based non-profit focused on addressing health disparities through community-driven solutions. Our work connects individuals to healthcare and essential social services while building strong partnerships across New York City. The Senior Manager will lead community outreach, partnership development, and oversee the NYREACH Navigator team to drive program growth and member engagement. This role is ideal for someone who can operate both in the field and internally; building relationships externally while ensuring strong execution and performance from the team. Job Summary The Compliance & Data Analyst will serve as a critical oversight, quality assurance, and audit-readiness role within the Community-Based Organization (CBO), supporting Social Care Network (SCN) activities under New York State’s 1115 Waiver. This role ensures that all SCN screenings, eligibility determinations, navigation activities, referrals, and documentation meet program requirements, PHS and SOMOS audit standards, and contractual compliance expectations. The position functions as both a compliance lead and operational analyst. The Analyst will create and maintain operating processes and policies, monitor day-to-day compliance, audit data for accuracy, and work closely with Navigators, Program Leads, and Directors to ensure a consistent level of compliance, accuracy, and audit readiness across the program.

Requirements

Bachelor’s degree required
Direct experience with 1115 Waiver programs, Social Care Networks, Medicaid, or managed care compliance strongly preferred
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

Nice To Haves

Master’s degree in public health, health administration, social work, or related field preferred

Responsibilities

Ensure eligibility assessments are completed within seven (7) calendar days of referral receipt, consistent with SCN and 1115 Waiver requirements
Track timeliness metrics and maintain audit-ready evidence of assessment completion
Escalate delays or barriers to Program Leads and Directors
Develop standard workflows to support timely eligibility determinations
Monitor all internal and external referrals to ensure closed-loop completion, as required by PHS and SOMOS audit standards
Conduct compliance follow-ups on open or aging referrals
Verify referral outcomes are documented clearly and accurately in member records
Flag and escalate 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 that navigation activities are supported by appropriate documentation and eligibility criteria
Partner with Navigators to resolve documentation gaps prior to billing or reporting
Ensure all 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 ten percent (10%) of enhanced-level members
Validate that 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 tied 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
Serve as the primary lead for all 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
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