Data Analyst

HMS is enterprising healthcare. We provide the broadest range of healthcare cost containment solutions in the industry – all to help payers like you improve performance.

The Data Analyst will support HMS Federal in providing program integrity services to the Medicare and Medicaid programs. Services will include predicting, detecting, preventing, and deterring fraud, waste and abuse. The Data Analyst shall be responsible for conducting analysis and research on Medicare and or Medicaid claims data and other data sources utilizing algorithms and tools to monitor for and address potential fraud, waste, and abuse in the Medicare and Medicaid programs while identifying overall program vulnerabilities

* Query and mine large data sets to identify patterns and trends that are indicative of potential fraud, waste, and abuse using traditional as well as predictive/advanced analytic methodologies * Provide on-going healthcare fraud, waste and abuse data, tool and analytics support to investigators and medical review staff * Develop specifications and extract data for data requests from all data sources, including, but not limited to the CMS Data Engine (a SAS environment) claim system. * Conduct quality checks on data by performing record counts, gap checks, duplicate checks, and other quality assurance tests of data. * Coordinate with Statistician to create audit sample in accordance with CMS guidance * Provide ongoing data analysis support as needed, including the development of scripts, algorithms, views, tables, databases, and spreadsheets * Conduct quality assurance reviews of data loaded into HMS Federal’s data repositories to ensure data loads are complete, accurate and conform to business requirements, this Includes reviews of work conducted by subcontractors and internal staff * Provide exceptions reports of data of poor quality to the appropriate operational team lead. Prepares reports and summarizes findings to the management staff and business partners **Other Functions:** * Performs other functions as assigned

* Analytical ability and business acumen to collect multiple sources of data and draw conclusions * Ability to learn new tools with minimum guidance and work independently. * Mastery of spreadsheets and analytical tools including Microsoft Excel and Microsoft Access * Demonstrated ability to meet and exceed project deadlines while producing high quality products * Knowledge of health care information (e.g., health claims data specifically Medicare and Medicaid), ICD-9/10-CM codes, and physician specialty codes) * Familiarity with the Centers of Medicare and Medicaid Services (CMS) Integrated Data Repository (IDR), One Program Integrity (One PI), Shared Systems, and/or Common Working File (CFW), and other fraud detection and prevention solutions * Knowledge of HIPAA Privacy and Security Rules and CMS security requirements **Work Conditions and Physical Demands:** * Primarily sedentary work in a general office environment * Ability to communicate and exchange information * Ability to comprehend and interpret documents and data * Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.) * Requires manual dexterity to use computer, telephone and peripherals * May be required to work extended hours for special business needs * May be required to travel at least 20% of time based on business needs **Minimum Education:** * Bachelor’s degree in healthcare or business administration, information technology, computer science or related field strongly preferred **Certifications: (Required/Desired)** * Certified Fraud Examiner (CFE), Accredited Health Care Fraud Investigator (AHFI) – Preferred * Not currently sanctioned or excluded from any program operated by Federal or State Agencies including Medicare and Medicaid - Required **Minimum Related Work Experience:** * 3 years of related data analysis experience including at least 1 year recent experience with Medicaid claims data and/or Medicare Part A, B, DME and Home Health claims data. Including 2+ years’ experience with SAS, Microsoft SQL, Business Objects or Crystal reporting