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Builds complex models for specific analysis using technology such as Python (Python, PySpark), R, SQL, SAS, Databricks. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review.
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Proficient in project software such as SAS/SQL, Python/PySpark, Snowflake, R, Databricks CMS cloud environments. 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.
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Experience or understanding of Medicare and Medicaid claims, ICD10 codes, HCPCS, Diagnosis Related Groups (DRG). Continuously evaluate impacts of policy and policy changes on fraud detection models. Uses this knowledge to construct fraud detection models.
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Relevant experience in a health-related, scientific, or public policy/business discipline with extensive quantitative methods/statistical knowledge. Build models and conduct analytics that contribute to Medicare and Medicaid fraud, waste and abuse efforts.
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The Senior Data Analyst works independently and collaboratively with Statistical and Data Analysts to provide analytical data support. Minimum 4-year degree in statistics, mathematics, computer science or related field or possesses a minimum of 6 years of data analysis experience within the healthcare industry.
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We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees professional development. 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.
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Confidence in merging disparate datasets, INNER/LEFT/RIGHT joins, and functions such as COALESCE(), CAST(), SAS functions such as SUBSTR(), LAG(), PROC SQL. Peer reviews Statistical and Data Analysts work and prepares reports on analysis.
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Identify outliers that exhibit patterns of fraud, waste, and abuse. Continuously learns Medicare and Medicaid policy and policy changes. o Follows the Standard Operating Procedures (SOPs), Desk Level Procedures (DLPs), Peer Review protocols and organization-wide policies and procedures.
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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.
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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.
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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. Applies knowledge of healthcare data and policy to known fraud schemes to hypothesize footprints the fraud schemes may leave in the data.
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Must pass post hire background screening checks. Proficient with Microsoft Office products such as Excel, Word, PowerPoint and Outlook. Provides subject matter expertise and guidance to Statistical and Data Analysts in learning to complete their tasks and assuring the quality of project deliverables.
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Identifies anomalies in health care data and follows up those anomalies to determine if they are indications of fraud. Adheres to all IntegrityM and/or client privacy and security protocols governing sensitive and/or business confidential information.
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Possesses a minimum of 3 years of data analysis experience within the healthcare industry. Advanced knowledge of analytic, mathematical, and statistical methods. At IntegrityM, we offer a culture of opportunity, recognition, collaboration, and supporting our community.
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Leads and/or participates in team projects and brainstorming sessions to assess various methodologies for study designs. Has 6 years of professional experience working with large and complex data sets.
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