Healthcare Data Analyst II

Seeking a full-time Medicare Data Analyst to perform waste and abuse detection, deterrence and prevention activities for Medicare claims. The Data Analyst II will use data and tools to perform comprehensive research, data analysis, and trending activities to support the identification of potential fraud, waste and abuse involving Medicare and Medicaid providers, suppliers and other entities receiving reimbursement under one or both of the Medicare and Medicaid programs

We offer our employees a competitive annual salary and full benefits that include paid holidays, vacation, health, dental and vision insurance, 401(k) plan with employer matching, Life, STD and LTD insurance and FlexSpend plan.

Responsibilities Include but Not Limited to:

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

Salary:

Commensurate with experience