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Healthcare Data Analyst

Posting Date: 12/29/2017
Job Number: 1184986
Location: Nashville, TN
Shift: 1st
Security Clearance Status:                 Not Applicable
Security Clearance Type: None
US Citizenship Required: No
Job Level: Individual Contributor
Employment Status: Regular Full-Time
Travel: Negligible

NCI: As the Healthcare Data Analyst ( Data Analyst I ) supporting AdvanceMed, you will perform in-depth evaluation and analysis of potential fraud cases and requests for information using claims information and other sources of data. You will support the development of complex cases that involve high dollar amounts, sensitive issues, or that otherwise meet criteria for vulnerability identifications, referral to law enforcement, recoupment of overpayment, and/or administrative action based on reactive and proactive data analysis.   In assuming this position, you will be a critical contributor to meeting NCI AdvanceMed's mission: To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse.

Highlights of Responsibilities:
  • Works with management, investigators, and analysts to provide reactive and proactive case development support and to fulfill law enforcement data requests.
  • Communicates effectively with internal and external customers, including federal law enforcement officers.
  • Validates data analysis results and analytically identifies potential fraud, waste and/or abuse situations in violation of Medicare/Medicaid laws, guidelines, policies, and regulations.
  • Supports management requests for CMS reporting requirements.
  • Utilizes data analysis tools and techniques to detect aberrancies in Medicare/Medicaid/Medi-Medi 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.
  • Works with Statisticians and Sr. Data Analysts to perform statistical sampling and extrapolations in support of program integrity investigations; to provide proactive data analysis results with statistically high probabilities of producing identification of program vulnerabilities, case referrals to law enforcement, overpayments, and/or administrative actions.
  • Prepares, develops and participates in provider, beneficiary, law enforcement, or staff training as related to fraud, waste and/or abuse data analysis within and across Medicare and Medicaid programs.
  • Maintains chain of custody on all documents and follow all confidentiality and security guidelines.

  • Bachelors degree in statistics or related discipline.
  • High proficiency level with Microsoft Office applications, especially MS Word and MS Excel.
  • Requires a working knowledge of SAS and/or other applications to perform various types of data analysis.
  • Previous experience in data analysis
  • Demonstrated knowledge of various database management systems in order to input, extract or manipulate information

Preferred Education and Experience:
  • MA or MS recipients.
  • Knowledge of Medicare and Medicaid rules and regulation
  • Demonstrated experience and knowledge of health care information (health claims data, ICD-9-CM codes, physician specialty codes, pharmaceutical data including NCPDP file formats and codes, provider identifiers, etc.)
  • Demonstrated knowledge of health care and claims or a combination of education and equivalent work experience.

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It is the policy of NCI to provide equal opportunity in recruiting, hiring, training, and promoting individuals in all job categories without regard to race, color, religion, national origin, gender, age, disability, genetic information, veteran status, sexual orientation, gender identity, or any other protected class or category as may be defined by federal, state, or local laws or regulations. In addition, we affirm that all compensation, benefits, company-sponsored training, educational assistance, social, and recreational programs are administered without regard to race, color, religion, national origin, gender, age, disability, genetic information, veteran status, sexual orientation, or gender identity. It is our firm intent to support equal employment opportunity and affirmative action in keeping with applicable federal, state, and local laws and regulations. 

The information above has been designed to indicate the general nature and level of work performed by employees within the classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this position. 

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