Senior Data Compliance Analyst – Utilization Management
WellSky
full-time
Posted on:
Location Type: Remote
Location: United States
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Job Level
About the role
- Overseeing and ensuring the accuracy, consistency, and reliability of client-submitted data
- Collaborating with internal and external stakeholders to uphold data quality standards
- Address discrepancies and support strategic decision-making through precise and dependable data insights
- Supporting the clinical compliance team with WellSky’s Utilization Management and Compliance Program
- Auditing and generating regulatory reports for CMS/Medicare, NCQA and Health Plan SLAs
- Collecting and organizing performance metrics
- Leading high-impact, cross-functional projects
- Driving process improvement initiatives
- Acting as a primary point of contact for escalated data issues
- Developing training materials, onboarding guides, and operational workflow documents
- Completing and successfully submitting CMS and compliance reports
- Analyzing data for logical inconsistencies and correcting data discrepancies
Requirements
- Bachelor's degree or equivalent work experience
- 4-6 years related work experience
- Active, unrestricted license – RN, PT, OT or SLP (preferred)
- Advanced knowledge of CMS utilization management compliance reports (preferred)
- Working knowledge of CMS UM audits (preferred)
- At minimum, 1-2 years of compliance experience focused on CMS and health plan audits (preferred)
- Excellent skills in data manipulation and sorting data for analytics and reporting (preferred)
- Advanced proficiency in Microsoft products, specifically Excel (preferred)
Benefits
- 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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
data analysisdata manipulationdata sortingcompliance reportingutilization managementauditingperformance metricsprocess improvementregulatory reporting
Soft Skills
collaborationleadershipcommunicationproblem-solvingattention to detail
Certifications
RNPTOTSLP