Job Description

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Job Responsibilities:

• Maintains strict confidentiality and security of all sensitive and/or business confidential information obtained or accessed during the course of business and/or contract operations.

• Adheres to all IntegrityM and/or client privacy and security protocols governing sensitive and/or business confidential information. Adheres to applicable policies and procedures ensuring commitment to quality, compliance and security to protect the confidentiality, integrity, and availability of sensitive data and information.

• Ensures compliance with all applicable privacy and security training requirements (both IntegrityM and external/client-based), whether on an annual or ad/hoc basis. Please note: certain position levels (leads, managers, directors or higher) may require additional "role-based" training to ensure compliance with applicable privacy and security requirements.

• Build models and conduct analytics that contribute to Medicare and Medicaid fraud, waste and abuse efforts. Applies knowledge of healthcare data and policy to known fraud schemes to hypothesize "footprints" the fraud schemes may leave in the data. Constructs and runs tests to validate these hypothesis. Uses this knowledge to construct fraud detection models.

• Identifies anomalies in health care data and follows up those anomalies to determine if they are indications of fraud. Identify outliers that exhibit patterns of fraud, waste, and abuse.

• Builds complex models for specific analysis using technology such as Python (Python, PySpark), R, SQL, SAS, Databricks.

• Manipulates and extracts Medicare, Medicaid, and other healthcare claims data stored in Cloud environment using appropriate software such as SAS, Snowflake, Python, R, SQL, and other software as appropriate for the task.

• Develop targeted analyses and related materials.

• Continuously learns Medicare and Medicaid policy and policy changes. Continuously evaluate impacts of policy and policy changes on fraud detection models.

• Support and participate in testing sprints and projects.

• Provides subject matter expertise and guidance to Statistical and Data Analysts in learning to complete their tasks and assuring the quality of project deliverables. Provides technical assistance. Peer reviews Statistical and Data Analysts' work and prepares reports on analysis.

• May serve as a Team Lead by planning, coordinating, and documenting project related activities, managing the team, as well as communicating directly with a client.

• Effectively communicates with and between technical and non-technical end users, providing clear explanation of procedures used and results obtained from data analysis tasks.

• Leads and/or participates in team projects and brainstorming sessions to assess various methodologies for study designs.

• Remains informed regarding industry changes, trends, best practices, and applicable regulations and assesses impact of changes on the project.

• Exercises appropriate discretion and independent judgment relating to company policies and practices in an effective, consistent, and professional manner.

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.
• Possesses a minimum of 3 years of data analysis experience within the healthcare industry.
• Advanced knowledge of analytic, mathematical, and statistical methods.
• Experience or understanding of Medicare and Medicaid claims, ICD10 codes, HCPCS, 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 such as SAS/SQL, Python/PySpark, Snowflake, R, Databricks CMS cloud environments.
• Proficient with Microsoft Office products such as Excel, Word, PowerPoint and Outlook.
• Knowledge of analytic methodologies and principles.
• Responds to tasks or requests in a cooperative and timely manner.
• Demonstrates adaptability to change and initiates or identifies change when necessary.
• Must be a team player.
• Works collaboratively with team members to meet the needs of the organization.
• Must be able to pass a public trust background check. Public trust in place preferred.

Additional Requirements:

Must pass post hire background screening checks.