Compliance Data Analyst

Compliance And Data Analyst

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 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.

Responsibilities

Eligibility Assessment & Timeliness (High Priority)

• 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

Closed-Loop Referral Oversight (High Priority)

• 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

Navigation & Billing Opportunity Review

• 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

Documentation Quality & Care Plan Compliance

• 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

Audit & Monitoring Functions

• 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

Client Action & Referral Validation

• 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

Policy, Process & Program Oversight

• 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

Reporting & Data Analysis

• 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

External Audit 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

Aligned Productivity Metrics & Compliance Targets

• 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

Qualifications

- Bachelor's degree required; Master's degree in public health, health administration, social work, or related field preferred

- 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

Equal Opportunity Employer

Essen Health care is proud to be an equal opportunity employer, and we seek candidates who desire to work in and serve an ethnically diverse population.