Healthcare Claims Senior Data Scientist

Type of Requisition:

Regular

Clearance Level Must Currently Possess:

None

Clearance Level Must Be Able to Obtain:

None

Public Trust/Other Required:

None

Job Family:

Data Science

Job Qualifications:

Skills:

Big Data, Data Analytics, Data Science, Predictive Modeling, Structured Query Language (SQL)

Certifications:

None

Experience:

7 + years of related experience

US Citizenship Required:

No

Job Description:

Our work depends on a Senior Data Scientist joining our team to support Centers for Medicare and Medicaid Services (CMS) anti-fraud activities. As a Senior Data Scientist supporting the Healthcare Fraud Prevention Partnership (HFPP), you will collaborate with a team of Data Scientists, Subject Matter Experts, and Business Intelligence Developers engaged in Fraud, Waste, and Abuse (FWA) analytics, to develop models and algorithms that detect and describe actionable FWA leads for the HFPP.

The Senior Data Science uses tools such as SAS and 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.

HOW A SENIOR DATA SCIENTIST WILL MAKE AN IMPACT:

• Responsible for 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.

• Facilitating 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 providing predictive analytic statistical support.

• Directing 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.

• Overseeing 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.

• Documenting 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.

• Guiding and instructing a team of 4-6 Data Scientists.

WHAT YOU'LL NEED TO SUCCEED:

• Masters Degree in Statistics or 7+ years of experience in statistical and computer-science related field(s).

• Proven track record delivering outstanding presentations to clients, stakeholders, and HFPP partners.

• Ability to effectively communicate the key insights and value propositions of the TTP analytic outputs.

• Extensive experience using Python software for healthcare Fraud, Waste and Abuse datamining and statistical modeling.

• Expertise using SQL software for healthcare Fraud, Waste and Abuse datamining and statistical modeling.

• Expertise 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.

• Experience successfully presenting FWA analytic outcomes to clients, stakeholders, and conferences.

• Expertise in medical terminology and all healthcare coding systems (e.g., ICD-10, CPT, HCPCS, DRG and the like).

• Demonstrated 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).

• 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 AND EXPERIENCE:

• 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.

SECURITY CLEARANCE LEVEL:

• The candidate selected for this role must be eligible to obtain a public trust clearance. This requires residency in the U.S. for 3 of the last 5 years.

WHAT GDIT CAN OFFER YOU:

• The GDIT HFPP Trusted Third Party is the only data warehouse of its type anywhere, bringing in many billions of healthcare claims from dozens of healthcare payers, including federal, state and local plans both public and private. We use this data warehouse solely for fraud, waste and abuse analytics.

• The TTP is responsible for identifying overpayments, fraud leads, and meaningful insights about abusive billing behaviors through a cross-payer lens. Government and private healthcare. organizations collaborated to form the HFPP as a public-private partnership to combat fraud, waste, and abuse.

• Competitive pay and benefits, flexible work schedule, collaborative inter-disciplinary environment where the best idea wins.

#GDITPublicHealthJobs

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The likely salary range for this position is $127,254 - $166,750. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.

Scheduled Weekly Hours:

40

Travel Required:

Less than 10%

Telecommuting Options:

Remote

Work Location:

Any Location / Remote

Additional Work Locations:

Total Rewards at GDIT:

Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year. Paid leave and paid holidays are prorated based on the employee’s date of hire. The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most.

We are GDIT. A global technology and professional services company that delivers consulting, technology and mission services to every major agency across the U.S. government, defense and intelligence community. Our 30,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 30 countries worldwide, offering leading capabilities in digital modernization, AI/ML, Cloud, Cyber and application development. Together with our clients, we strive to create a safer, smarter world by harnessing the power of deep expertise and advanced technology.

We connect people with the most impactful client missions, creating an unparalleled work experience that allows them to see their impact every day. We create opportunities for our people to lead and learn simultaneously. From securing our nation’s most sensitive systems, to enabling digital transformation and cloud adoption, our people are the ones who make change real.

Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans