Sr. Healthcare Data Analyst: Python, Medicare & Medicaid (Full-time, Remote)

Full-Time Employee

Remote

http://www.integritym.com

About Us

Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review.

At IntegrityM, we offer a culture of opportunity, recognition, collaboration, and supporting our community. We thrive off of these fundamental elements that make IntegrityM a great place to work. Our small, flexible workplace offers an exceptional quality of life and promotes corporate-driven sustainability. We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees’ professional development. Large company perks…Small company feel!

In this role, the Senior Data Analyst possesses an in-depth knowledge of health care systems, intermediate computer and software skills, and the ability to accomplish all delegated tasks achieving Integrity Management Services business goals of producing high quality deliverables for our clients. The Senior Data Analyst works independently and collaboratively with Statistical and Data Analysts to provide analytical data support.

Job Responsibilities:

• Maintains strict confidentiality and security of all sensitive and/or business confidential information obtained or accessed during the course of business and/or contract operations.

• Adheres to all IntegrityM and/or client privacy and security protocols governing sensitive and/or business confidential information. Adheres to applicable policies and procedures ensuring commitment to quality, compliance and security to protect the confidentiality, integrity, and availability of sensitive data and information.

• Ensures compliance with all applicable privacy and security training requirements (both IntegrityM and external/client-based), whether on an annual or ad/hoc basis. Please note: certain position levels (leads, managers, directors or higher) may require additional “role-based” training to ensure compliance with applicable privacy and security requirements.

• Build models and conduct analytics that contribute to Medicare and Medicaid fraud, waste and abuse efforts. Applies knowledge of healthcare data and policy to known fraud schemes to hypothesize “footprints” the fraud schemes may leave in the data. Constructs and runs tests to validate these hypothesis. Uses this knowledge to construct fraud detection models.

• Identifies anomalies in health care data and follows up those anomalies to determine if they are indications of fraud. Identify outliers that exhibit patterns of fraud, waste, and abuse.

• Builds complex models for specific analysis using technology such as Python (Python, PySpark), R, SQL, SAS, Databricks.

• Manipulates and extracts Medicare, Medicaid, and other healthcare claims data stored in Cloud environment using appropriate software such as SAS, Snowflake, Python, R, SQL, and other software as appropriate for the task.

• Develop targeted analyses and related materials.

• Continuously learns Medicare and Medicaid policy and policy changes. Continuously evaluate impacts of policy and policy changes on fraud detection models.

• Support and participate in testing sprints and projects.

• Adheres to IntegrityM Quality Assurance procedures including:

o   Follows the Standard Operating Procedures (SOPs), Desk Level Procedures (DLPs), Peer Review protocols and organization-wide policies and procedures

o   Resolves problems that might affect or be encountered by others.

o   Identifies and shares best practices that could be helpful to others.

o   Documents all work by following established procedures. 

o   Provides recommendations for overall quality improvement.

• Provides subject matter expertise and guidance to Statistical and Data Analysts in learning to complete their tasks and assuring the quality of project deliverables. Provides technical assistance. Peer reviews Statistical and Data Analysts’ work and prepares reports on analysis.

• May serve as a Team Lead by planning, coordinating, and documenting project related activities, managing the team, as well as communicating directly with a client.

• Effectively communicates with and between technical and non-technical end u