ResponsibilitiesSafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.
We are seeking an accomplished Statistician to support CMS program integrity initiatives across the Northeastern jurisdiction through advanced statistical sampling, extrapolation, and data analytics. In this role, you will develop and defend statistically valid methodologies that support healthcare claims reviews, audits, investigations, and overpayment determinations, directly contributing to the identification and recovery of improperly paid Medicare and Medicaid funds.
What you'll do:
Develop sampling designs to support Medicare and Medicaid compliance and estimate the overpayments to be recovered by recoupment, offset, or otherwise;
Collaborate with Investigations, Audits, and Medical Review staff to develop projection methodologies consistent with the client policy manuals, e.g. IOM 100-08, IOM 100-15, IOM 100-16 and State’s policies;
Extract data from multiple systems; use various statistical tools and techniques for sampling, projections and analysis to determine valid overpayment estimates to support recovery of erroneously paid Medicare or Medicaid funds;
Present results of statistical work to non-statistical audiences, including investigators, law enforcement agents, hearing appeal officers and people at all levels.
Telework available from anywhere in the US
Qualifications
Required Qualifications:
Education and Statistical Experience:
Candidates must meet one of the following requirements:
- Master's degree (M.A., M.S., or equivalent) in Statistics or a related field (e.g., Biostatistics, Econometrics, Mathematics, or Psychometrics) with significant coursework in probability, sampling, and estimation methodologies and at least four (4) years of experience applying statistical sampling methods and interpreting results;
OR
- Doctoral degree (Ph.D. or equivalent) in Statistics or a related field (e.g., Biostatistics, Econometrics, Mathematics, or Psychometrics) with significant coursework in probability, sampling, and estimation methodologies and at least one (1) year of experience applying statistical sampling methods and interpreting results.
Program Integrity Experience (that includes either Medicare, Medicaid, or Private Payer)
- Experience developing statistically valid sampling plans and extrapolations consistent with CMS Program Integrity Manual (PIM) requirements.
- Experience defending statistical methodologies during appeals, administrative hearings, or other review proceedings preferred.
- Knowledge of Medicare Parts A, B, C, and D claims data, provider billing practices, and healthcare reimbursement methodologies.
- Experience working with healthcare claims data in the realm of statistics or analytics.
Technical Qualifications
- Proficiency with statistical software and programming languages, including Python and SAS.
- Experience with Microsoft Office applications, including Excel, Access, and Word.
- Experience with healthcare data management and reporting tools, including Business Objects, Databricks, or similar platforms.
Professional Competencies
- Strong analytical, quantitative, and problem-solving skills.
- Excellent written and verbal communication skills, with the ability to present complex statistical concepts to technical and non-technical audiences.
- Ability to work independently and collaboratively in a team environment while delivering high-quality work products.
- Strong interpersonal skills.
Additional Requirement
Target Salary Range$80,000 - $128,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual’s experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.
