Data Analyst II
Data Analyst II - REMOTE
Company Overview:
CoventBridge Group is the leading worldwide full-service investigation solutions company providing: Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs. With offices in the UK and U.S. the company provides top tier data privacy and security practices, deploys robust case management technology customized to clients’ needs and delivers worldwide coverage via its 1000 employees and affiliates worldwide.
About the Opportunity:
The Data Analyst II will primarily be responsible for performing in-depth evaluation and analysis of potential fraud cases and requests for information using claims information and other sources of data. In addition, it will support 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.
In assuming this position, you will be a critical contributor to meeting CoventBridge Group's objective: To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse.
The Data Analyst II position will report to the Data Supervisor and will work in our Grove City, OH office or if not local, remotely from a home office. Ideal candidates will reside in one of the following areas: Chicago, Detroit, Des Moines, Kansas City, St. Louis, Indianapolis, Columbus, Cincinnati, Louisville.
Responsibilities:
- Work with local management, investigators, and analysts to provide reactive and proactive case development support and to fulfill law enforcement data requests.
- Communicate effectively with internal and external customers, including federal law enforcement officers.
- Validate data analysis results and analytically identify potential fraud, waste and/or abuse situations in violation of Medicare/Medicaid laws, guidelines, policies, and regulations.
- Support management requests for CMS reporting requirements.
- Utilize data analysis techniques to detect aberrancies in Medicare/Medicaid claims data and proactively seeks out and develops leads and cases received from a variety of sources including CMS and OIG, fraud alerts, and referrals from government and private sources.
- Work with Statisticians and Data Analysts to provide proactive data analysis results with statistically high probabilities of producing case referrals to law enforcement, overpayments, and/or administrative actions.
- Prepare, develop and participate in provider, beneficiary, law enforcement, or staff training as related to Medicare fraud, waste and/or abuse data analysis.
- Maintain chain of custody on all documents and follow all confidentiality and security guidelines.
- Comply with and maintains various documentation and other reporting requirements as needed.
- Perform other duties as assigned.
Requirements:
- Demonstrated knowledge of various database management systems in order to input, extract or manipulate information.
- Have high proficiency level with MS Access and MS Excel.
- Requires a working knowledge of SAS and/or other applications to perform various types of data analysis.
- Knowledge of Medicare and Medicaid rules and regulation is a plus.
- 2 years’ experience in data analysis as well as demonstrated knowledge of health care and claims or a combination of education and equivalent work experience is preferred but not necessary.
- Demonstrated experience and knowledge of health care information (health claims data; specifically, Medicare and Medicaid, ICD-9-CM and ICD-10-CM codes, physician specialty codes, pharmaceutical data including NCPDP file formats and codes, provider identifiers, etc.) is preferred but not necessary.
Educational Qualifications:
- Bachelor’s degree in statistics or related discipline with preference given to MA or MS recipients.
- Associate must have and maintain a valid driver’s license issued by his/her state of residence.
Benefits:
- Medical, Dental, Vision plans
- Life, LTD and STD paid by the employer
- 401(k) with company match up to 4%
- Paid Time Off and company paid holidays
- Tuition assistance after 1 year of service
*CoventBridge is proud to be an EEO-AA employer M/F/D/V and maintains a Drug-Free Workplace.*