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Healthcare Fraud Data Analyst, Senior
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Key Role: Grow with our compliance and anti-fraud team with the responsibility to perform advanced analyses to ensure the integrity of the client’s health programs. Generate innovative ideas for creative solutions and collaborate with other subject matter experts to ensure specialized topics are appropriately addressed. Conduct active surveillance of notable or emerging trends in program payment structures. Assist the client in efforts to identify and assess exposure or vulnerability to fraud, waste, and abuse in programs and provide support and assistance to state program integrity functions. Assess and monitor the impact of policy and payment changes on access to care, beneficiary health outcomes, and program payments, while applying healthcare payer expertise to address payer strategic and operational priorities. Basic Qualifications: 5+ years of experience using statistical methodologies to identify vulnerabilities in Medicare, Medicaid, and Managed Care programs Experience with health care information, such as health claims data and ICD-10 codes, physician specialty codes, survey and certification data, and provider and supplier identifiers Experience in statistical detection of potential healthcare fraud and abuse, using tools, such as predictive modeling, development of mathematical models, neural networks, healthcare data analytics, and data mining Experience in data access tools, such as SAS, SQL, Python, and R Experience in the design, management, and oversight of databases Experience with Medicare claims and pharmacy drug data Knowledge of Medicare Parts A, B, C, and D, and DME benefits Ability to obtain a security clearance Bachelor’s degree in a Healthcare, Science, Public Health, Policy, Statistics, Mathematics, or Economics field Additional Qualifications: Experience delivering sensitive information and technical content to a wide range of stakeholders and using a variety of delivery techniques Experience in facilitating large meetings with both internal and external audiences Knowledge of the federal procurement and proposal process, and contract management principles Knowledge of CMS claims data, including Medicare, Medicaid, and Marketplace, in the IDR or CCW environment with Fee-for-Service (FFS), Medicare Advantage encounter data, Medicaid data in the Transformed Medicaid Statistical Information System (T-MSIS), or Prescription Drug Event (PDE) data Knowledge of CMS program integrity related systems and resources Ability to apply automation techniques to drive insights and efficiency Ability to work collaboratively and build effective working relationships Accredited Healthcare Fraud Investigator (AHFI), Health Care Anti-Fraud Associate (HCAFA), Certified Insurance Fraud Investigator (CIFI), Certified Financial Crimes Investigator (CFCI), Certified Fraud Examiner (CFE), Certified in Healthcare Compliance (CHC), CPC, CEMA, or CPMA certifications Clearance: Applicants selected will be subject to a security investigation and may need to meet eligibility requirements for access to classified information. #J-18808-Ljbffr
