Job Description

Location: Park Ridge, NJ

Reports to: General Counsel/Compliance Leadership | Full time

About us: We deliver HRSN services (screening, navigation, care management and meal delivery for NY Medicaid members under the SCN initiative, working with MCOs and community partners.

Responsibilities

• Build and lead the SCN/HRSN compliance program
• Audit billing, documentation, eligibility, and claims accuracy
• Ensure data privacy/security compliance for member and referral data
• Run risk assessments on fraud/waste/abuse, eligibility, and contracts
• Oversee compliance in Lead Entity and MCO partnerships
• Train internal teams and partners on requirements
• Monitor Medicaid/1115 waiver regulations; update policies accordingly
• Manage complaint/incident resolution and reporting
• Partner cross functionally with ops, IT, finance, and legal
• Support audit readiness and respond to state/MCO inquiries

Qualifications

• Bachelor’s degree required (JD/MHA/MPH/MBA or CHC/CCEP/CHPC preferred)
• 5+ years healthcare compliance experience, with Medicaid focus
• Track record building compliance programs, audits, and corrective actions
• Strong knowledge of Medicaid billing, eligibility, FWA, and HIPAA
• Ability to translate complex regulations into practice across stakeholders
• Strong analytical, communication, and cross functional influence skills

Nice to Have

• NY Medicaid, HCBS, behavioral health, or SDOH experience
• Auditing background in screening/navigation/care coordination
• Exposure to 1115 waivers or demonstration programs

Direct SCN experience not required transferable Medicaid compliance expertise is welcome.

Offer: Competitive pay, direct access to senior leadership/legal and a chance to build compliance infrastructure for a mission driven program.

Send your resume

Experience Required

5-6 years