Healthcare Fraud Data Analyst Iv - Remote - Contingent

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for under-served communities.

Are you an experienced data analytics professional seeking to further your career in healthcare data analytics?  Qlarant has the perfect opportunity for a motivated candidate to join our PPI MEDIC data analytics team!  This position requires strong analytical skills and previous SAS, Python, R, SQL and/or other statistical programming and database work experience. This is a remote position but could be located in our Easton or Baltimore, MD offices if preferred.  We offer opportunities for advancement, a collaborative and inclusive work environment and a very competitive benefits package.

Please Note:  This is not an immediate opening. Offers for this position are contingent on the award of the contract to Qlarant.  

In this role you will be a part of a dedicated and talented data analytics team focused on making a positive difference in the future of the Medicare Parts C and D programs.  The PPI MEDIC supports the Centers for Medicare and Medicaid’s fraud, waste and abuse monitoring efforts in the Medicare Parts C and D programs. The primary goal of the PPI MEDIC is to analyze Parts C and Part D data, conduct audits of plans, provide outreach and education to plan sponsors, and ensure compliance with regulatory requirements of Medicare Parts C and D. 

Job Summary: Mid-level professional who performs study design, data analysis, and report preparation.  Studies originate from preliminary data analysis (trends), literature review, experience and expertise of the team, and mandated projects.  Data analysis, including data preparation and presentation of findings is performed in conjunction with other analysts. Reports are drafted by teams with leadership of data Scientists.

Essential Duties and Responsibilities:

• Trend data to identify potential opportunities (e.g., variances, significant outliers, percentile ranked groups) for quality improvement or focused investigations.
• Design data analysis strategies to identify potential areas for quality improvement or focused investigation.
• Develop epidemiological sound indicators of the quality of care.
• Analyst data and summarize into quality indicator values
• Identify external benchmarks of care for comparative purposes.
• Develop tabular and graphical presentations of data which clearly and concisely illustrate current levels of care.
• Write draft reports which clearly and concisely illustrate current levels or care.
• Contribute to the development of interventions (i.e., develop educational materials for doctors and nurses) which will improve healthcare processes and outcomes.
• Design re-measurement strategies (after intervention) of healthcare processes and outcomes to effectively quantify impact of interventions for improvement.
• Analyze re-measurement data and summarize into quality indicator values.
• Develop reports concerning all of the above.
• Mentor junior Data Analysts in all technical aspects of their work.
• Prepare draft manuscripts for publishing in peer reviewed journals.
• Has developed expertise with standard concepts, practice and procedures in field. Relies on limited experience and judgment to plan and accomplish goals.
• Performs a variety of tasks some requiring independent thought and research. A degree of creativity and latitude is required.

Language Skills

• Ability to read, analyze, and interpret common scientific and technical and professional journals, technical procedures, or governmental regulations.
• Ability to write reports, business correspondence, and procedure manuals.
• Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Mathematical Skills

• Ability to apply advanced mathematical concepts such as probability and statistical inference.
• Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
• Ability to apply mathematical operations to such tasks as frequency distribution, determination of test reliability and validity, analysis of variance, correlation techniques, sampling theory, and factor analysis.

Reasoning Ability

• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

Other Skills and Abilities

• To perform this job successfully, an individual should have fluency in SAS or other statistical programming software and MS Office.
• Ability to work independently and in teams. Must possess strong analytical skills with an understanding of the principles of epidemiology and biostatistics.
• Ability to work with highly sensitive information while preserving the confidentiality of the information.
• Working knowledge of healthcare systems, Medicare/Medicaid, preferred, healthcare databases and coding systems.

• Bachelor's degree (BA or BS) required, preferably in Statistics, Biostatistics, Applied Mathematics, Business Analytics, Public Health or related discipline (e.g., Economics, Engineering, Computer Science).
• Minimum of 4 years of hands-on SAS or other statistical programming work experience, or demonstrated equivalent combination of education and experience (Masters Degree and 2 years of experience).
• 1-2 years’ experience with health related analytic research and quality improvement methodology (ISO, CQI, TQM, Six Sigma, Lean, etc.) preferred.

Qlarant, Inc is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.