Data Scientist

Type of Requisition:

Regular

Clearance Level Must Currently Possess:

None

Clearance Level Must Be Able to Obtain:

None

Public Trust/Other Required:

None

Job Family:

Data Science

Job Qualifications:

Skills:

Analytics, Data Analytics, Data Science

Certifications:

None

Experience:

5 + years of related experience

US Citizenship Required:

No

Job Description:

Our work depends on a Data Scientist joining our team to support Centers for Medicare and Medicaid Services anti-fraud activities. As a Data Scientist supporting the Healthcare Fraud Prevention Partnership (HFPP), you will engage with a team of Data Scientists working in Fraud, Waste and Abuse (FWA) analytics, collaborating with FWA Subject Matter Experts and Business Intelligence Developers to innovate, develop and maintain FWA models and algorithms that detect and describe actionable FWA leads for the HFPP.

The Data Scientist works directly with the Data Science team in using tools such as Snowflake, Jupyter Notebooks, and Python to analyze healthcare claims across Medicare, Medicaid and private payers within a multi-billion record database made up of a large partnership of public and private healthcare payers. Your will be part of a 7-person Data Science team supporting the Trusted Third Party fraud, waste and abuse data analytics.

HOW A DATA SCIENTIST MANAGER WILL MAKE AN IMPACT:

• This position work with a team of Data Scientists with a multi-disciplinary organization of Data Scientists, Business Intelligence Analysts and FWA Subject Matter Experts. Our team is 100% remote and distributed throughout the country.

• This position will be responsible for working on the development and execution of FWA models and algorithms in multi-payer environments by creating, reviewing, and maintaining statistical analysis plans, providing data interpretation and generating reports in support of proposed research questions.

• The Data Scientist will engage with the Data Science team’s collaboration with FWA Subject Matter Experts, Business Intelligence Developers, and clients, to develop meaningful analyses for FWA modeling results and provide predictive analytic statistical support.

• The Data Scientist selected for this position will assist in the innovation, design and maintenance of automated data pipelines, in collaboration with other data engineers and Business Intelligence Developers, feeding analytic outputs to a sever environment where HFPP Partners will interact with their analytic outputs.

• The Data Scientist must have a proven track record delivering outstanding presentations to clients, stakeholders, and effectively communicate the key insights and value propositions of the TTP analytic outputs.

• The Data Scientist will work as a developer/coder and they will also engage in quality review on analytic output to ensure consistency with protocol and adequacy to meet methodological objectives, and to ensure compliance with applicable access standards.

• The Data Scientist will document processes, best practices, and strategies for existing and future FWA models and algorithms on behalf of the Data Science team, optimizing business efficiencies as it relates to process improvement.

WHAT YOU'LL NEED TO SUCCEED:

• Master’s Degree in Statistics or related field or an equivalent combination of education and experience.

• 5-8 years experience in statistical and computer-science related field(s).

• Experience using SQL and Python software for healthcare Fraud, Waste and Abuse datamining and statistical modeling.

• Experience with client relation activities, ingesting and synthesizing customer requirements, and effectively communicating complex healthcare analytic outcomes to client satisfaction.

• Experience successfully presenting FWA analytic outcomes to clients, stakeholders, and conferences.

• Expertise in medical terminology and all healthcare coding systems (e.g., ICD-10, CPT, HCPCS, DRG and the like).

• Experience datamining for healthcare fraud, waste and abuse in large, multi-payer databases with diverse health care benefit structures and claim processing systems, including private plans (commercial insurance) as well as Federal and State public plans (Medicare and Medicaid).

• Experience researching, interpreting and applying payer medical (coverage) policies (e.g., LCDs, NCDs, private carrier medical policies) and common industry claim edits (e.g., NCCI).

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