Data Analyst- Medicare Part Claims

LivantaLLC
Full time
Healthcare
United States
Hiring from: United States
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.

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