Compliance Data Architect

Rendr•New York, NY

22h

About The Position

The Compliance Data Architect is responsible for developing, designing, producing, and interpreting complex data sets within the compliance department and implementing advanced analytical models to identify compliance risks, ensure regulatory adherence, detect and prevent fraud, waste, and abuse, and support risk-based strategic decision-making within the compliance department. The ideal candidate will have a strong background in healthcare compliance, data science, and statistical analysis, with a deep understanding of current Federal and New York State healthcare regulations and trends. This role requires expertise in transforming raw data into actionable insights through analysis, intuitive visualization, and effective communication.

Requirements

Bachelor's degree in Data Science, Statistics, Computer Science, or a related field; Master's degree preferred.
Minimum five (5) years of healthcare-related work experience with reporting and analytics, including data extraction, manipulation, statistical modeling, and data visualization.
Proven experience in advanced analytics, data visualization, data modeling, and statistical analysis.
Strong understanding of compliance regulations and risk management.
Proficiency in analytical tools, machine learning, data visualization, data reconciliation, and data management including SQL and Microsoft Power BI.
Excellent problem-solving skills and attention to detail.
Strong communication skills with the ability to present complex data insights to nontechnical stakeholders.
Expert proficiency in Excel, including creating pivot tables.
Ability to use various tools to create visualizations of analysis results.
Familiarity with Federal and NYS Regulations.
Previous experience in compliance-related roles, such as corporate compliance, the OIG, the NYS OMIG, Health plan SIUs.
Strong understanding of industry-specific compliance regulations and best practices.
Experience working with electronic medical record (EMR) systems and healthcare data including patient records and claims data.
Experience in designing and preparing reports for the Compliance Committee and/or Board of Directors.
Experience and familiarity with Fraud, Waste, and Abuse (FWA), Centers for Medicare & Medicaid Services (CMS), Drug Enforcement Agency (DEA), Food and Drug Administration (FDA), Office of Civil Rights (OCR) and Health Insurance Portability and Accountability Act (HIPAA).

Nice To Haves

Certified in Healthcare Compliance (CHC), highly preferred.

Responsibilities

Lead the development and implementation of advanced analytical models to identify and mitigate compliance risks in a timely manner.
Collaborate closely with cross-functional teams to extract, analyze, and validate data from various sources and prioritize business needs.
Develop departmental dashboards, reports, and visualizations to monitor compliance metrics and trends.
Provide insights and recommendations based on quantitative and qualitative data analysis.
Support and ensure compliance with regulatory requirements through data-driven strategies.
Stay updated on industry trends and best practices in compliance analytics.
Apply sophisticated data analysis techniques, including machine learning and predictive modeling, to identify and prevent fraud, waste, and abuse within the Medicaid program.
Utilize detection methods such as pattern recognition, outlier analysis, and predictive modeling to proactively detect suspicious patterns and irregularities in data.
Enhance the ability to apply analytics across multiple data sources including but not limited to the electronic medical record (EMR), Compliance, Billing, and Clinical.
Develop advanced data analysis based on the compliance department workplan, utilize departmental incident management platform, and leverage advanced analytics and metric monitoring to identify trends and outliers.
Conduct analyses to routinely and proactively detect suspicious patterns and irregularities across all data sets.
Conduct outlier analysis by identifying data points that are impossible or significantly deviate from expected trends.
Design and deliver reports and visual narratives that provide insights from analysis of data in line with Compliance initiatives.
Create predictive models by developing machine-learning algorithms to forecast trends.
Continuously monitor analytics results and issues identified.
Conduct trend analysis and provide data-driven insights into recurring issues or policy violations.
Analyze data from various internal and external sources to understand key information that can be used for proactive compliance risk identification, benchmarking, data visualization, and data reconciliation.
Translate complex datasets into intuitive visual formats to support compliance presentations to the Board of Directors and other relevant stakeholders as needed.