Seeking a full-time, remote, Data Analyst II with experience in managing, interpreting, and analyzing healthcare insurance claims or Medicare and/or Medicaid data claims. This position requires proficiency in business tools (e.g., SAS, SQL, and/or other data warehouse applications) to query large datasets and perform various types of data analysis. This position requires a Bachelor’s degree in Math, Statistics, or related discipline and at least two years of experience in data analytics.
Summary Description
Perform in-depth evaluation and analysis of potential fraud cases and requests for information using claims information and other sources of data. Support the development of complex cases that involve high dollar amounts, sensitive issues, or that otherwise meet criteria for referral to law enforcement, recoupment of overpayment, and/or administrative action based on reactive and proactive data analysis.
Accountabilities
Work with local management, investigators, and analysts to provide reactive and proactive case development support and to fulfill law enforcement data requests
Communicate effectively with internal and external customers, including federal law enforcement officers
Validate data analysis results and analytically identify potential fraud, waste and/or abuse situations in violation of Medicare/Medicaid laws, guidelines, policies, and regulations
Support management requests for CMS reporting requirements
Utilize data analysis techniques to detect aberrancies in Medicare/Medicaid claims data and proactively seeks out and develops leads and cases received from a variety of sources including CMS and OIG, fraud alerts, and referrals from government and private sources
Work with Statisticians and Data Analysts to provide proactive data analysis results with statistically high probabilities of producing case referrals to law enforcement, overpayments, and/or administrative actions
Prepare, develop and participate in provider, beneficiary, law enforcement, or staff training as related to Medicare fraud, waste and/or abuse data analysis
Maintain chain of custody on all documents and follow all confidentiality and security guidelines
Comply with and maintains various documentation and other reporting requirements as needed
Perform other duties as assigned
Qualifications
Education (general level if required) or specific courses Bachelor’s degree in statistics or related discipline with preference given to MA or MS recipients, and/or relevant work experience as a data analyst.
Associate must have and maintain a valid driver’s license issued by his/her state of residence
Skills, Knowledge
Abilities (SKA) Have high proficiency level with MS Access and MS Excel
Requires a working knowledge of SAS and/or other applications to perform various types of data analysis.
Knowledge of Medicare and Medicaid rules and regulation is a plus
Experience 2 years’ experience in data analysis as well as demonstrated knowledge of health care and claims or a combination of education and equivalent work experience.
Demonstrated knowledge of various database management systems in order to input, extract or manipulate information.
Demonstrated experience and knowledge of health care information (health claims data; specifically, Medicare and Medicaid, ICD-9-CM and ICD-10-CM codes, physician specialty codes, pharmaceutical data including NCPDP file formats and codes, provider identifiers, etc.) is preferred
