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Senior Data Compliance Analyst – Utilization Management
Location
United States
Posted
87 days ago
Salary
0
Seniority
Senior
Job Description
Senior Data Compliance Analyst – Utilization Management
WellSky
• 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
Job 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
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TX-HHSC-DSHS-DFPSJoin the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey.
DSHS is committed to hiring skilled and dedicated individuals who share a passion for public health to pursue our vision of A Healthy Texas. If you are looking to make an impact and tackle new challenges, we encourage you to consider a career with us. Employee Benefits: DSHS offers insurance coverage and other benefits available through the State of Texas Group Benefits Plan administered by the Employee Retirement System of Texas (ERS). To learn more about all the benefits available to you as a DSHS employee and other DSHS opportunities for early career pathways, visit the DSHS Careers Page. Review our Top 10 Tips for Success when Applying to State of Texas Jobs. Functional Title: DSHS Privacy Officer Job Title: Privacy Analyst III Agency: Dept of State Health Services Department: Compliance Operations Posting Number: 11532 Closing Date: 04/27/2026 Posting Audience: Internal and External Occupational Category: Office and Administrative Support Salary Group: TEXAS-B-25 Salary Range: $5,797.66 - $7,000.00 Pay Frequency: Monthly Shift: Day Additional Shift: Telework: Eligible for Telework Travel: Up to 15% Regular/Temporary: Regular Full Time/Part Time: Full time FLSA Exempt/Non-Exempt: Exempt Facility Location: Job Location City: AUSTIN Job Location Address: 1100 W 49TH ST (RDM) Other Locations: Austin MOS Codes: 4502,4505,165X,35PX,3N0X6,46A,INF,ISS Under the supervision of the Compliance Operations Director, the Privacy Analyst III (DSHS Privacy Officer) performs highly advanced (senior-level) privacy consultative and technical assistance work and oversees the daily operations and activities of the Privacy Office. 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Works to integrate privacy practice into routine business operations by developing and implementing privacy controls, policies, standards, guidelines, and operating procedures. Maintains agency wide privacy policies, notices of privacy practices, policy supplements, and internal procedures. Coordinates and/or reviews privacy and security controls. Monitors for and proposes solutions to privacy risks through incident response management and consultation with program areas. EJF4. (10%) Monitors, reviews, and analyzes privacy-related legislation. Tracks employee compliance with annual, mandated privacy training. Gathers, organizes, and quantifies privacy and security surveys and questionnaire responses to improve privacy training. Provides regular reports to agency leadership. EJF5. (10%) Coordinates with HHSC (Health and Suman Services Commission) Privacy Division to develop and implement privacy policies, procedures, standards, and controls. Coordinates with HHSC Privacy Division to develop and implement privacy awareness and compliance activities, such as training and communications. EJF6. (5%) Performs other duties as assigned. Other duties as assigned include but are not limited to active participation and/or support to meet the agency’s obligations for disaster response and/or recovery or continuity of operations activation. Such participation may require an alternate shift pattern, assignment, and/or location Knowledge, Skills and Abilities (KSAs): Working knowledge of HIPAA, information privacy, federal and state privacy laws, and/or compliance with regulatory directives. Effective interpersonal and leadership skills. Experience preparing oral and written reports, managing projects, and facilitating meetings. Ability to prepare effective correspondence and reports for diverse audiences, including executives and senior managers. Ability to collect, analyze information and solve work problems. Ability to make independent judgments and provide guidance to agency staff. Working knowledge of public health and/or health and human services programs is preferred. Experience developing policies and regulations is preferred. Registrations, Licensure Requirements or Certifications: Professional certification in information privacy, information security, or compliance is required or must be attained within twelve months of hire. Preference will be given to candidates who hold the Certified Information Privacy Professional (CIPP/US) certification is required, however other relevant professional certifications will be considered. Initial Screening Criteria: Graduation from an accredited four-year college or university with major course work in public policy, public administration, public health, political science, legal studies, information management or a related discipline is required. A master’s or other graduate degree is preferred. 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