Data Jobs in Bronx, NY

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Compliance & Data Analyst

Essen Medical Associates Bronx, NY

Bronx, NY

Today

$66k - $70k/yr Full time Compliance Compliance Monitoring Compliance Reporting

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Job Description

Compliance and operational analytics for NYREACH’s Social Care Network (SCN) under New York State’s 1115 Waiver.

Responsibilities

Ensure eligibility assessments are completed within seven (7) calendar days of referral receipt, aligned with SCN and 1115 Waiver requirements
Track timeliness metrics and maintain audit-ready evidence showing assessment completion
Escalate delays or barriers to Program Leads and Directors
Build and maintain standard workflows that support timely eligibility determinations
Monitor internal and external referrals to ensure closed-loop completion per PHS and SOMOS audit standards
Perform 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 navigation activities are supported by appropriate documentation and eligibility criteria
Partner with Navigators to resolve documentation gaps prior to billing or reporting
Ensure 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 10% of enhanced-level members
Validate 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 related 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
Lead 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

Requirements

Bachelor’s degree required; Master’s degree in public health, health administration, social work, or related field preferred
Strong understanding of audit processes, documentation standards, and compliance monitoring
Advanced analytical, reporting, and organizational skills
Ability to collaborate with Navigators, Program Leads, Directors, and external partners
Strong attention to detail and documentation accuracy
Advanced Microsoft Excel skills
Proficiency in Teams, Outlook, Word, and PowerPoint
Experience with 1115 Waiver programs, Social Care Networks, Medicaid, or managed care compliance strongly preferred
Experience supporting internal or external audits in a healthcare or social services setting

Technologies

Microsoft Excel
Microsoft Teams
Microsoft Outlook
Microsoft Word
Microsoft PowerPoint

Key Performance 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

Location & Compensation

Location: Bronx, NY (onsite)
Salary: USD 66,300 - 70,000 per year

Equal Opportunity Employer: NYREACH – New York Research, Education & Community Health, Inc., 2021 Grand Concourse, Bronx, NY 10453

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