Healthcare Claims Sr. Data Scientist at ATR Arena Technical Resources

Job Title: Healthcare Claims Sr. Data Scientist
Location: Remote
Eligibility: US Citizenship required. This position supports a Federal
program.

Our client’s work depends on a Senior Data Scientist joining the 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 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. 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:

- Guide 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.

- Responsible for the development and overseeing the development and
execution of FWA models and algorithms in multi-payer environments
by designing, creating, reviewing, and maintaining statistical
analysis plans, providing data interpretation and generating reports
in support of proposed research questions.

- 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.

- 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.

- 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.

- Oversee 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.

- 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 and SQL software for healthcare
Fraud, Waste and Abuse data-mining 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.

Arena Technical Resources, LLC, (ATR) is an Equal Opportunity Employer
(EOE) who will provide equal employment opportunity to employees and
applicants for employment without regard to race, ethnicity, religion, color,
sex, pregnancy, national origin, age, veteran status, ancestry, sexual
orientation, gender identity or expression, marital status, family structure,
genetic information, or mental or physical disability.