Compliance Data Analyst
Tasks
- Analyze trends and identify operational or compliance risks
- Conduct compliance follow ups on open referrals
- Conduct routine member audits
- Create and maintain compliance policies and operating procedures
- Decline or return referrals lacking documentation
- Document audit findings corrective actions and resolution timelines
- Ensure documentation meets SCN and audit standards
- Ensure eligibility assessments within required timelines
- Flag and escalate unresolved referrals
- Lead audit preparation data validation and documentation submission
- Maintain alignment with waiver and program guidance
- Maintain audit logs and supporting evidence
- Maintain continuous audit readiness
- Monitor referral completion and document outcomes
- Obtain required responses and documentation
- Produce compliance productivity and audit readiness reports
- Review navigation records for billing opportunities
- Track and report client action closure status
- Track timeliness metrics and maintain audit evidence
- Update care plans based on screenings and referrals
- Validate client action items and referral documentation
- Validate documentation and eligibility for navigation activities
Perks/Benefits
- N/A
Skills/Tech-stack
Audit compliance | Care Plan | Care plan management | Compliance Monitoring | Data Analysis | Documentation review | Eligibility assessment | Plan management | Referral Tracking | Reporting | Risk Analysis | Workflow development
Education
Roles
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