Full Job Description
In this role, the Senior Data Analyst possesses an in-depth knowledge of health care systems, expertise with healthcare claims (Medicare and Medicaid), intermediate computer and software skills, and the ability to produce high quality deliverables for our clients. The Senior Data Analyst works independently and collaboratively with Statistical and Data Analysts to provide analytical data support.
Job Responsibilities:
• Develops and implements models and analytical approaches that support Medicare and Medicaid fraud, waste, and abuse (FWA) detection efforts. Applies healthcare data and policy expertise to known fraud schemes to hypothesize the "footprints" such schemes may leave in the data.
• Designs and executes tests to validate these hypotheses and leverages findings to build effective fraud detection models.
• Detects anomalies in healthcare data and investigates potential indicators of fraudulent activity. Identifies outliers that demonstrate patterns consistent with fraud, waste, or abuse.
• Constructs advanced models for targeted analysis using tools such as Python, R, SQL and SAS.
• Extracts and manipulates Medicare, Medicaid, and other healthcare claims data housed in cloud environments using software tools including Python, R, SQL, SAS and others as appropriate to the task.
• Designs and executes targeted analyses and develops related materials to support project goals.
• Maintains ongoing knowledge of Medicare and Medicaid policies, including updates and changes. Evaluates the implications of policy changes on fraud detection models and adjusts methodologies accordingly.
• Participates in and supports testing sprints and related project initiatives.
• Provides subject matter expertise and guidance to Statistical and Data Analysts.
• Assists in task execution and ensures quality of project deliverables through peer review and technical assistance.
• Prepares detailed analytical reports.
• May serve as a Team Lead, responsible for planning, coordinating, and documenting project activities, managing team performance, and serving as a primary liaison with clients.
Requirements
Job Qualifications:
• Minimum 4-year degree in statistics, mathematics, computer science or related field or possesses a minimum of 6 years of data analysis experience within the healthcare industry.
• Has 6 years of professional experience working with large and complex data sets.
• Advanced knowledge of analytic, mathematical, and statistical methods.
• Experience with healthcare claims data, specifically Medicare and Medicaid claims.
• Experience or understanding of ICD10 codes, HCPCS, and Diagnosis Related Groups (DRG).
• Confidence in merging disparate datasets, INNER/LEFT/RIGHT joins, and functions such as COALESCE(), CAST(), SAS functions such as SUBSTR(), LAG(), PROC SQL.
• Relevant experience in a health-related, scientific, or public policy/business discipline with extensive quantitative methods/statistical knowledge.
• Proficient in project software: SAS, Python, R and/or SQL.
• Proficient with Microsoft Office products such as Excel, Word, PowerPoint and Outlook.
• Knowledge of analytic methodologies and principles.
• Knowledge of program integrity data analytics.
• Responds to tasks or requests in a cooperative and timely manner.
• Demonstrates adaptability to change and initiates or identifies change when necessary.
• Strong customer service, organizational, analytical skills.
• Ability to use complex mathematical calculations.
• Excellent leadership and presentation skills.
• Ability to work independently and as a member of a team to deliver high quality work.
• Ability to multitask and prioritize assignments while meeting deadlines.
Additional Requirements:
• Must pass post hire background screening checks.
• For remote work, required to have wired and/or wireless internet access.
• Ability to obtain security clearance, if required by Client/Contract.
Benefits
This position is eligible for the benefits applicable to full-time regular employees, such as: vacation, sick leave, paid holidays, health insurance, dental insurance, vision insurance, short- and long-term disability, life insurance, employee assistance plan, 401(K) retirement plan, and educational benefits.
U.S. remote annual salary range: $70,000-$100,000/annual
For candidates in jurisdictions requiring range disclosure, this is the good-faith range for this role; final pay may vary by work location and job-related factors such as skills, experience, location, and internal equity. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.
