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Data Analyst II

Company NCI Information Systems, Inc.
Location Knoxville, TN
Update 8 Day ago
NCI: As the Healthcare Data Analyst ( Data Analyst II ) 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.
  • Complies with and maintains various documentation and other reporting requirements as needed.

  • 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.
  • At least 2 years of 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.