Seeking a full-time Healthcare Data Statistician to perform fraud, waste and abuse detection and prevention activities.
Performs in-depth evaluation and analysis of potential fraud cases and requests for information using claims information and other sources of data. Supports the development of complex cases that involve high dollar amounts, sensitive issues, or that otherwise meet criteria for referral to law enforcement, recoupment of overpayment, and/or administrative action based on reactive and proactive data analysis.
A demonstrated knowledge of health care and claims or a combination of education is preferred. Knowledge of statistical analysis, algorithm development, which may be gained during academic studies.
Knowledge of or coursework in MS Excel, SAS, SQL and/or other applications to perform various types of data analysis.
Demonstrated experience and knowledge of health care information (health claims data specifically Medicare and Medicaid , ICD-9-CM codes, physician specialty codes, pharmaceutical data including NCPDP file formats and codes, provider identifiers, etc) is preferred.
Demonstrated oral and written communication.
Master’s degree in any Statistical or Mathematical fields, or a closely related field such as Engineering, Computer Science/Engineering/Applications, Management Information Systems, Industrial Engineering/Management or foreign degree equivalent (May also include a combination of degrees equating to a U. S. Master’s degree).
Must have and maintain a valid driver’s license issued by the state of residence. Preferred work location(s): Nashville, TN. Work from home will be considered for well-qualified candidates that live in one of the states below.
Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia
Commensurate with experience