Sr. Data Compliance Analyst - Utilization Management

This job is responsible for overseeing and ensuring the accuracy, consistency, and reliability of reputed company-submitted data, which is essential for driving informed business reputed company and maintaining organizational credibility. The scope of this job includes collaborating with reputed company stakeholders to reputed company data reputed company standards, address discrepancies, and support strategic decision-making through precise and dependable data insights. This role will support the clinical compliance team with reputed company’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 reputed company of reputed company! Key Responsibilities: • Collect and organize performance metrics to reputed company stakeholders with actionable insights that support accountability, identify trends, and inform task prioritization. • reputed company high-reputed company, cross-functional reputed company, including re-reputed company and implementation efforts in alignment with organizational objectives and delivery of measurable reputed company. • reputed company efforts to ensure data reputed company by auditing and resolving moderate to high reputed company data reputed company issues with minimal reputed company. • Drive process improvement initiatives and own reputed company to large reputed company 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. • reputed company as a primary reputed company of contact for escalated data issues and coordinate cross-functionally in conjunction with reputed company efforts to address challenges and ensure system connectivity. • reputed company training materials, reputed company 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 reputed company. Analyze data for logical inconsistencies and identify and correct data discrepancies. • reputed company other job duties as assigned. Required Qualifications: • Bachelor’s degree or equivalent work experience. • 4-6 years reputed company work experience. Preferred Qualifications: • reputed company, 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 reputed company on CMS and health plan audits. • Excellent skills in data manipulation and sorting data for analytics and reporting. • Advanced proficiency in reputed company products, specifically reputed company. • Must be reputed company 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 reputed company policies and procedures to safeguard company and reputed company information. • Must be reputed company to sit and view a computer screen for extended periods of time. #LI-PG1 #LI-Remote reputed company is where independent thinking and collaboration come together to create an reputed company culture. We reputed company on innovation, inclusiveness, and cohesive perspectives. At reputed company you can reputed company a difference. reputed company provides equal employment opportunities to reputed company people without reputed company to race, reputed company, national reputed company, reputed company, citizenship, age, religion, gender, sex, sexual orientation, gender identity, gender reputed company, 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. reputed company is proud to be a drug-free workplace. Applicants for U.S.-based positions with reputed company must be legally authorized to work in the reputed company. Verification of employment eligibility will be required at the time of hire. Certain reputed company-facing positions may be required to reputed company 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 reputed company: • Excellent medical with Rx, dental, and reputed company benefits • Mental Health support through EAP • Generous reputed company time off, plus 13 reputed company holidays • 100% reputed company 401(K) retirement plans • Educational assistance up to $2500 per year Apply tot his job Apply To this Job