Hi,
Hope you are doing great!!
Please go through the requirement and kindly send me the updated resume ASAP
Location: Fully Remote Duration: 1 Year
These will be Data science/SAS Programmer/Data modeler type of people with a strong focus on R and CMS
Responsibilities: - Analyze claims data and develop requirements for sustainable predictive analytic models and edits
- Working with the team and client to understand data and client needs
- Detect potential weakness and vulnerabilities susceptible to fraud
- Lead working groups with customers, investigators, and other contractors to elicit and evaluate vulnerabilities
- Prevent FWA using system edits, policy recommendations, and customer/user education
- Train Gov Agency staff and partner contractors on proactive data analysis, investigations, internet research, etc.
- Assist with the analysis of vulnerabilities and data anomalies
- Monitor claims and suspicious activities utilizing proven investigating techniques
- Reporting and communicating regarding the effectiveness of fraud prevention activities
- Build and provide oversight to predictive analytics team.
- Communicates with internal and external sources related to potentially fraudulent activity
- Provides input on new ways of identifying fraud as well as improving existing fraud models
- Works with technical staff to test fraud models
- Participates in meetings and events representing the customer and employer
Requirements: - Bachelor Degree or Higher in related field of study, and 8+ years of Data Analytics / Predictive Modeling experience for enterprise-level systems.
- 5+ years of experience in fraud prevention related field(s), including fraud detection, investigation, forensic accounting, judiciary, and law enforcement
- Must have direct experience with Medicare & Medicaid claims coding, processing systems, healthcare enrollment/eligibility data, as well as healthcare claims data including CPT, ICD 9 and ICD 10 codes
- Expertise in one or more of the following areas:
- Predictive analytics/modeling
- Data mining
- Machine Learning
- SPSS, R, Python
- Practical knowledge of insurance laws and industry regulations, Medicare program rules and regulations, as well as federal, state & local laws and ordinances pertaining to medical services and professions.
- Knowledge of anti-fraud principles, Healthcare policy, & Legislation
- Knowledge of the Medicare FFS programs (coverage, payment rules and regulation and claims process).
- Experience with Agile project methodologies (preferably SAFe)
- Exceptional communication skills both verbal & written, with end clients & key stakeholders
| | Thanks and Regards Sachin Mishra | | | | | | |
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