Data Scientist/Data Modeler/SAS Programmer any with R programming

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

Comments

Popular Posts