Data Analyst- Medicare Part Claims

Description

DATA ANALYST

Job Summary

We are seeking a detail-oriented and analytical Data Analyst with experience in Medicare Part C data to join our team. The successful candidate will be responsible for collecting, processing, and analyzing healthcare data to support the Centers for Medicare & Medicaid Services (CMS) in detecting and preventing fraud, waste, and abuse (FWA) within the Medicare Advantage (Part C) program.

Key Responsibilities

• Data Collection and Management:
• Collects, manages, and analyzes data from various sources, including pharmacies, dispensers, and manufacturers, to identify trends and potential compliance issues.
• Gather and organize data from various sources, including Medicare Part C claims, provider records, and beneficiary information.
• Ensure data quality and integrity through rigorous validation and cleaning processes.
• Data Analysis:
• Perform detailed data analysis to identify trends, patterns, and insights related to Medicare Part C.
• Use statistical methods and data visualization tools to interpret and present findings.
• Develop and implement algorithms and models to detect potential FWA activities.
• Reporting and Documentation:
• Develops data models, dashboards, and reports that summarize key findings and support decision- making for program leadership.
• Develop comprehensive reports and dashboards to communicate data insights to stakeholders.
• Document methodologies, processes, and findings in a clear and concise manner.
• Collaboration and Support:
• Work closely with cross-functional teams, including data scientists, policy analysts, and healthcare professionals, to support data-driven decision-making.
• Provide technical support and training to team members on data analysis tools and techniques.
• Compliance and Security:
• Ensures data integrity and accuracy throughout all program-related analysis, including during audits and investigations.
• Ensure compliance with all relevant data privacy and security regulations, including HIPAA.
• Implement best practices for data governance and management.
  
  

Requirements

Required Qualifications:

• Education:
• Bachelor’s degree in Data Science, Statistics, Computer Science, Public Health, or a related field. Master’s degree preferred.
• Experience:
• Minimum of 2 years of experience in data analysis, preferably in the healthcare sector.
• Experience in supporting data analysis within the context of fraud, waste, abuse, and investigations.
• Proven experience working with Medicare Part C data.
• Familiarity with CMS data systems and regulatory requirements.
• Experience working with large datasets.
• Technical Skills:
• Proficiency in data analysis tools and programming languages such as SQL, Python, R, and Excel.
• Experience with data visualization tools like Tableau, Power BI, or similar.
• Knowledge of statistical analysis and modeling techniques.
• Soft Skills:
• Strong analytical and problem-solving skills.
• Excellent communication and presentation skills.
• Ability to work independently and collaboratively in a team environment.
• Attention to detail and a commitment to data accuracy.
  
  

Preferred Qualifications

• Experience with Medicare Advantage (Part C) risk adjustment and payment models.
• Knowledge of healthcare policy and regulatory environments.
• Certification in data analysis or related fields.