Senior Data Analyst, Clinical Quality and Product
Omada Health
PythonSQLTableau
Lead Inpatient Data Analyst
Integrity Management Services, Inc.
part-time
Posted on:
Location Type: Remote
Location: Remote • Virginia • 🇺🇸 United States
Visit company websiteJob Level
Senior
About the role
- Assist in the development of comparative billing reports (CBR) and programs to evaluate payment patterns electronic reports (PEPPER) reports in support of CMS’s effort to reduce Medicare fee-for-service improper payments.
- Uses data science techniques to perform and review tasks such as:
- Data Analysis on large data sets
- Data Mining
- Statistical Analysis, and
- Text Mining
- Participate in the evaluation of target areas for all PEPPER types, providing recommendations for discontinuation or identifying new target areas that could benefit specific facility types.
- Conduct claims data analysis to assist in the development of PEPPER reports targeted to physicians, suppliers, pharmacies and other medical professionals.
- Conduct research to support topic development and work with the data analytics staff in creating report metrics.
- Assist with analyzing outlier data to identify target patterns, other anomalous patterns and report findings as well as support ad-hoc reports and special studies as needed.
- Develops and reviews models using machine learning techniques.
- Applies Natural Language Processing (NLP) and Artificial Intelligence (AI) frameworks to address business challenges and support data-driven decision-making.
- Continuously learning (staying up-to-date) Medicare policy changes and updates.
- Support the development of educational materials and activities (webinars, conference calls) to support CMS, stakeholders and other contractors in using the report data.
- Support the ongoing review and updates of all PEPPER User Guides and related documentation across all PEPPER types.
- Support CMS and other contractors with provider questions related to report findings.
- Attends meetings, trainings, and conferences as needed or available
- Exercises appropriate discretion and independent judgment relating to company policies and practices in an effective, consistent and professional manner.
- Able to maintain quality and meet expectations.
- May provide subject matter expertise in areas of clinical nursing, quality, education, mentoring, or peer reviews.
- 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.
- Exercises appropriate discretion and independent judgment relating to company policies and practices in an effective, consistent and professional manner.
Requirements
- Bachelor’s Degree in nursing, statistics, mathematics, computer science or related field or possesses a minimum of 4 years data analysis experience within the healthcare industry.
- Experience in reviewing Medicare and Medicaid claims for appropriate billing and medical coding requirements, performing medical review, and/or developing fraud cases.
- Demonstrated proficiency in medical review work.
- Strong analytic and research skills.
- Preferred working knowledge of Medicare and/or Medicaid programs.
- Knowledge of medical terminology, ICD-9-CM, ICD-10-CM HCPCS level II and CPT coding along with analysis and processing of Medicare claims. Utilizes Medicare/Medicaid and Contractor guidelines for coverage determinations.
- Knowledge of analytic methodologies and principles.
- Responds to tasks or requests in a cooperative and timely manner.
- Demonstrates adaptability to change and initiates or identifies change when necessary.
- Strong customer service, organizational, analytical skills.
- Demonstrates strong proficiency in oral and written communication, interpersonal relations, and organizational effectiveness.
- Ability to take initiative, to maintain confidentiality, to meet deadlines, and to work in a team environment.
- Ability to handle confidential material.
- Ability to work independently and as a member of a team to deliver high quality work.
- Ability to multitask and prioritize assignments while meeting deadlines.
- Proficiency in Microsoft Office products such as Excel, Word, PowerPoint and Outlook.
- Passion and alignment with IntegrityM’s mission, vision, values and operating principles.
- Must pass post hire background screening checks.
- For remote work, required to have wired and/or wireless internet access.
- Ability to obtain security clearance, if requested by Client/Contract.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
data analysisdata miningstatistical analysistext miningmachine learningnatural language processingartificial intelligenceICD-9-CM codingICD-10-CM codingCPT coding
Soft skills
analytical skillsresearch skillscustomer serviceorganizational skillsoral communicationwritten communicationinterpersonal relationsadaptabilityinitiativeconfidentiality
