Data Analyst- Medicare Part C Claims

Description

DATA ANALYST

Job Summary

We are seeking a detail-oriented and analytical Data Analyst with experience in Medicare Part C data to join our team. The successful candidate will be responsible for collecting, processing, and analyzing healthcare data to support the Centers for Medicare & Medicaid Services (CMS) in detecting and preventing fraud, waste, and abuse (FWA) within the Medicare Advantage (Part C) program.

Key Responsibilities
• Data Collection and Management:
• Collects, manages, and analyzes data from various sources, including pharmacies, dispensers, and manufacturers, to identify trends and potential compliance issues.
• Gather and organize data from various sources, including Medicare Part C claims, provider records, and beneficiary information.
• Ensure data quality and integrity through rigorous validation and cleaning processes.
• Data Analysis:
• Perform detailed data analysis to identify trends, patterns, and insights related to Medicare Part C.
• Use statistical methods and data visualization tools to interpret and present findings.
• Develop and implement algorithms and models to detect potential FWA activities.
• Reporting and Documentation:
• Develops data models, dashboards, and reports that summarize key findings and support decision- making for program leadership.
• Develop comprehensive reports and dashboards to communicate data insights to stakeholders.
• Document methodologies, processes, and findings in a clear and concise manner.
• Collaboration and Support:
• Work closely with cross-functional teams, including data scientists, policy analysts, and healthcare professionals, to support data-driven decision-making.
• Provide technical support and training to team members on data analysis tools and techniques.
• Compliance and Security:
• Ensures data integrity and accuracy throughout all program-related analysis, including during audits and investigations.
• Ensure compliance with all relevant data privacy and security regulations, including HIPAA.
• Implement best practices for data governance and management.

Requirements

Required Qualifications: • Education: • Bachelor’s degree in Data Science, Statistics, Computer Science, Public Health, or a related field. Master’s degree preferred. • Experience: • Minimum of 2 years of experience in data analysis, preferably in the healthcare sector. • Experience in supporting data analysis within the context of fraud, waste, abuse, and investigations. • Proven experience working with Medicare Part C data. • Familiarity with CMS data systems and regulatory requirements. • Experience working with large datasets. • Technical Skills: • Proficiency in data analysis tools and programming languages such as SQL, Python, R, and Excel. • Experience with data visualization tools like Tableau, Power BI, or similar. • Knowledge of statistical analysis and modeling techniques. • Soft Skills: • Strong analytical and problem-solving skills. • Excellent communication and presentation skills. • Ability to work independently and collaboratively in a team environment. • Attention to detail and a commitment to data accuracy.

Preferred Qualifications
• Experience with Medicare Advantage (Part C) risk adjustment and payment models.
• Knowledge of healthcare policy and regulatory environments.
• Certification in data analysis or related fields.

Livanta LLC is an equal employment opportunity employer. All personnel processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military and veteran status or any other characteristic protected by applicable law.

If you need assistance or an accommodation due to a disability, you may contact us at 757-306-4920 or [email protected].

Apply Job!

For more such jobs please click here!