Senior Data Scientist (Federal Healthcare/ Fraud, Waste and Abuse) - REMOTE
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Guide a team of Data Scientists engaged in Fraud, Waste and Abuse (FWA) analytics, collaborating with FWA Subject Matter Experts and Business Intelligence Developers to develop to develop FWA models and algorithms that detect and describe actionable FWA leads for the HFPP.
Guides the Data Science team in using tools such as SQL, SnowSQL, Python and Tableau to analyze healthcare claims across Medicare, Medicaid and private payers within a multi-billion record database made up of a large partnership of public and private healthcare payers.
Our work depends on a Senior Data Scientist joining our team to support Centers for Medicare and Medicaid Services anti-fraud activities.
As a Senior Data Scientist supporting the Healthcare Fraud Prevention Partnership (HFPP), you will guide a team of Data Scientists engaged in Fraud, Waste and Abuse (FWA) analytics,
collaborating with FWA Subject Matter Experts and Business Intelligence Developers to design and develop FWA models and algorithms that detect and describe actionable FWA leads for the HFPP.
The Senior Data Scientist directs the Data Science team in using tools like SQL, SnowSQL, Python to analyze healthcare claims across Medicare, Medicaid and private payers within a multi-billion record database made up of a large
partnership of public and private healthcare payers. The Data Science team is part of a 8-person team supporting the Trusted Third Party fraud, waste and abuse data analytics.
In this role, a typical day will include:
This position guides a team of Data Scientists, embedded within a multi-disciplinary organization of Data Scientists, Business Intelligence Analysts and FWA Subject Matter Experts. Our team is 100% remote and distributed throughout the country.
This position will be responsible for development and overseeing the development and execution of FWA models and algorithms in multi-payer environments by desiging, creating, reviewing, and maintaining statistical analysis plans, providing data interpretation and generating reports in support of proposed research questions.
The Senior Data Scientist will facilitate the Data Science team s collaboration with FWA Subject Matter Experts, Business Intelligence Developers, and clients, to develop meaningful analyses for FWA modeling results and provide predictive analytic statistical support.
The Senior Data Scientist selected for this position will direct the design and maintenance of automated data pipelines, in collaboration with data engineers and Business Intelligence Developers, feeding analytic outputs to a sever environment where HFPP Partners will interact with their analytic outputs.
The Senior Data Scientist must have a proven track record delivering outstanding presentations to clients, stakeholders, and HFPP Partners, and effectively communicate the key insights and value propositions of the TTP analytic outputs.
The Senior Data Scientist oversees development standards adherence and quality review on analytic output to ensure consistency with protocol and adequacy to meet methodological objectives, and to ensure compliance with applicable access standards.
The Senior Data Scientist will document processes, best practices, and strategies for existing and future FWA models and algorithms on behalf of the Data Science team, optimizing business efficiencies as it relates to process improvement.
This team member will guide and instruct a team of 4-6 Data Scientists.
REQUIRED QUALIFICATIONS
Masters Degree in Statistics or 7+ years of experience in statistical and computer-science related field(s).
5+ years of experience using Python software for healthcare Fraud, Waste and Abuse datamining and statistical modeling.
5+ years of experience using SQL software for healthcare Fraud, Waste and Abuse datamining and statistical modeling.
5+ years of experience using Tableau software for healthcare Fraud, Waste and Abuse model presentation.
5+ years client relation activities, ingesting and synthesizing customer requirements and effectively communicating complex healthcare analytic outcomes to client satisfaction.
5+ years successfully presenting FWA analytic outcomes to clients, stakeholders, and conferences.
5+ years expertise in medical terminology and all healthcare coding systems (e.g., ICD-10, CPT, HCPCS, DRG and the like).
5+ years of experience datamining for healthcare fraud, waste and abuse in large, multi-payer databases with diverse health care benefit structures and claim processing systems, including private plans (commercial insurance) as well as Federal and State public plans (Medicare and Medicaid).
5+ years of experience researching, interpreting and applying payer medical (coverage) policies (e.g., LCDs, NCDs, private carrier medical policies) and common industry claim edits (e.g., NCCI).
Prior experience managing or leading multi-person data analytics teams with a focus on healthcare data; strong supervisory experience leading project teams and/or mentorship ability guiding new analysts.
Demonstrated expertise in the complete Microsoft Office Suite including: Word, Excel, and PowerPoint (candidate may be called upon to show examples from portfolio or submit practicum assignments).
DESIRED QUALIFICATIONS
Experience in Amazon Web Services (AWS) cloud and/or Snowflake data warehouse environments.
Ability to communicate technical outcomes with a high degree of detail and precision to technical audiences, while at the same time being able to communicate those outcomes to non-technical audiences in an approachable and understandable manner.
Exceptional problem-solving abilities, accuracy with work, strong organizational skills, attention to detail and the ability to multi-task while meeting deadlines.
Excellent communication skills, both written and verbal, and especially the ability to communicate data clearly to clients.
Ability to work in a fast-paced, team-oriented environment with minimal supervision.
