Sr. Data Compliance Analyst - Utilization Management

This job is responsible for overseeing and ensuring the accuracy, consistency, and reliability of client-submitted data, which is essential for driving informed business decisions and maintaining organizational credibility. The scope of this job includes collaborating with internal and external stakeholders to uphold data quality standards, address discrepancies, and support strategic decision-making through precise and dependable data insights. 

This role will support the clinical compliance team with WellSky’s Utilization Management and Compliance Program in regulatory reporting by serving as a clinical expert on state and federal regulations. The role will work closely with the clinical compliance managers, auditing and generating regulatory reports for CMS/Medicare, NCQA and Health Plan SLAs.

We invite you to apply today and join us in shaping the future of healthcare!

Key Responsibilities:

• Collect and organize performance metrics to provide stakeholders with actionable insights that support accountability, identify trends, and inform task prioritization.
• Lead high-impact, cross-functional projects, including re-onboarding and implementation efforts in alignment with organizational objectives and delivery of measurable outcomes.
• Lead efforts to ensure data integrity by auditing and resolving moderate to high complex data quality issues with minimal oversight.
• Drive process improvement initiatives and own medium to large projects to enhance database functionality, address inefficiencies, and support organizational goals.
• Utilize advanced research and analytical skills to assess trends and ensure compliance with evolving policies or regulations.
• Act as a primary point of contact for escalated data issues and coordinate cross-functionally in conjunction with client efforts to address challenges and ensure system connectivity.
• Develop training materials, onboarding guides, and operational workflow documents to ensure consistent knowledge transfer across teams.
• Complete and successfully submit CMS and compliance reports including the ODAG, Part C, Reopening, and Complaints and Grievance Reports.
• Generate regulatory reports on a weekly, monthly, or quarterly cadence. Analyze data for logical inconsistencies and identify and correct data discrepancies.
• Perform other job duties as assigned.

Required Qualifications:

• Bachelor's degree or equivalent work experience.
• 4-6 years related work experience.

Preferred Qualifications:

• Active, unrestricted license – RN, PT, OT or SLP.
• Advanced knowledge of CMS utilization management compliance reports.
• Working knowledge of CMS UM audits. At minimum, 1-2 years of compliance experience focused on CMS and health plan audits.
• Excellent skills in data manipulation and sorting data for analytics and reporting.
• Advanced proficiency in Microsoft products, specifically Excel.
• Must be able to prioritize, plan and handle multiple tasks/demands simultaneously.

Job Expectations:

• Willing to work additional or irregular hours as needed.
• Must work in accordance with applicable security policies and procedures to safeguard company and client information.
• Must be able to sit and view a computer screen for extended periods of time.

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WellSky is where independent thinking and collaboration come together to create an authentic culture. We thrive on innovation, inclusiveness, and cohesive perspectives. At WellSky you can make a difference.

WellSky provides equal employment opportunities to all people without regard to race, color, national origin, ancestry, citizenship, age, religion, gender, sex, sexual orientation, gender identity, gender expression, marital status, pregnancy, physical or mental disability, protected medical condition, genetic information, military service, veteran status, or any other status or characteristic protected by law. WellSky is proud to be a drug-free workplace.

Applicants for U.S.-based positions with WellSky must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Certain client-facing positions may be required to comply with applicable requirements, such as immunizations and occupational health mandates.

Here are some of the exciting benefits full-time teammates are eligible to receive at WellSky:

• Excellent medical with Rx, dental, and vision benefits

• Mental Health support through EAP

• Generous paid time off, plus 13 paid holidays

• 100% vested 401(K) retirement plans

• Educational assistance up to $2500 per year