Healthcare Program Integrity Data Analyst

Job Description

Healthcare Program Integrity Data Analyst

Key Role:

Collaborate and support the growth of an analytics team with responsibility to perform advanced analyses and studies of Centers for Medicare and Medicaid Services (CMS). Assist CMS with health care and payment policy rulemaking activities. Monitor and assess the impact of policy and payment changes on access to care, beneficiary health outcomes, and Medicare payments. Conduct active surveillance of notable trends in Medicare payment systems. Assist CMS in its efforts to identify and assess exposure to fraud, waste, and abuse in the Medicare program. Evaluate the impact of initiatives aimed at preventing or recovering improper payments. Conduct numerous and varied ad hoc data analyses. This position is open to remote delivery anywhere within the U.S., to include the District of Columbia.

Basic Qualifications:

• 5+ years of experience in a managerial role overseeing projects, budgets, and staff
• Experience with working with Government Payer programs
• Experience with building analytic solutions and products and developing payer data analysts
• Knowledge of CMS claims data, including Medicare and Medicaid, in either the Integrated Data Repository (IDR) or Chronic Conditions Warehouse (CCW) environment with Fee-for-Service (FFS), Medicare Advantage encounter data, or Prescription Drug Event (PDE) data
• Knowledge of analytic scripting, programming languages and packages, including SAS Viya, R, Python, Tableau, QuickSight, or Qlik
• Knowledge of both federal and state payer data, including encounter data, fraud, and program integrity tactics
• Ability to apply Artificial Intelligence (AI) and Machine Learning (ML) and automation techniques to drive insights and efficiency
• Ability to obtain a security clearance
• Bachelor's degree

Additional Qualifications:

• Experience with delivering technical assistance to a wide range of stakeholders and using a variety of delivery techniques
• Experience with facilitating large meetings with both internal and external audiences
• Experience with the federal procurement and proposal process
• Knowledge of or experience with Amazon WebServices (AWS) or specifically the CMS AWS Enclave

Clearance:

Applicants selected will be subject to a security investigation and may need to meet eligibility requirements for access to classified information.

Compensation:

The proposed salary range for this position in Colorado is 135,000 to 150,000. Final salary will be determined based on various factors.

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