Data Analyst (Remote)

NCI Information Systems, Inc. - Reston, VA3.6

Full-time

NCI: As the Data Analyst (Statistician II) supporting AdvanceMed, you will apply advanced analytics to identify potential fraud cases 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, recoupment of over payment, and/or administrative action based on 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:

  • Designs, develops, implements and/or reviews innovative analytical approaches, statistical methods and procedures, algorithms and predictive modeling techniques for reactive or proactive data analysis to detect healthcare fraud, waste and abuse
  • Assesses any limitations of the healthcare claims data, in terms of reliability or usability, resolves issues within the existing methodology and proposes work around methodologies to increase analytical efficiency
  • Validates and/or reviews data analysis results to identify violations of laws, guidelines, policies and regulations, and provide case development support in Medicaid
  • Develops and/or reviews reports to identify potential program or systematic vulnerabilities in Medicaid, Medicare or other programs
  • Researches the fields, healthcare policies, best practices and other relevant information to ensure that the most appropriate statistical techniques and/or methods are utilized
  • Evaluates statistical methods and procedures
  • Utilizes data analysis techniques to detect aberrancies in claims data
  • Complies with all confidentiality and security guidelines
  • Complies with and maintain various documentation and other reporting requirements
  • Uses computer software, including SQL, R, Python and/or other applications for assigned projects
  • Performs other duties as needed and assigned by Manager

Required Experience:

  • Master’s Degree in any Statistical or Mathematical fields, or a closely related field such as Engineering, Computer Science/Engineering/Applications, Management Information Systems, Industrial Engineering/Management or foreign degree equivalent (May also include a combination of degrees equating to a U. S. Master’s degree)
  • 2 – 7 Years in healthcare analytics, preferably working with claims data
  • Knowledge of SQL and/or other applications to perform various types of data analysis

Preferred Education and Experience:

  • Knowledge of statistical analysis, algorithm development
  • Experience with Medicaid and Medicare
  • Experience working with large data-sets
  • Experience with Python and R

Job Type: Full-time

Experience:

  • healthcare claims analytics: 2 years (Required)
  • Medicare/Medicaid Fraud, Waste and Abuse: 2 years (Preferred)

Education:

  • Master's (Preferred)

Work authorization:

  • United States (Required)