Compliance Data Analyst
About The Position
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
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What This Job Offers
Job Type
Full-time
Career Level
Senior
