Healthcare Claims Data Analyst

Data Analyst

At GDIT, people are our differentiator. Our work depends on a Data Analyst joining our team to support Centers for Medicare and Medicaid Services anti-fraud activities. As a Data Analyst supporting the Healthcare Fraud Prevention Partnership (HFPP), you will develop fraud, waste and abuse (FWA) analytics from concept to finished product at the Trusted Third Party (TTP), working against a multi-billion record claims warehouse assembled from dozens of public and private healthcare payers. HFPP Partners and the client bring the questions. You turn them into analytics that identify aberrant billing and hold up to scrutiny. You will engage with healthcare claims and FWA analytics working alongside experienced Subject Matter Experts, and you do need to be genuinely strong with data.

How a Healthcare Claims Data Analyst will make an impact:

• Working with a multi-disciplinary team of Data Scientists, Business Intelligence Developers and FWA Subject Matter Experts. Our team is 100% remote and distributed throughout the country.
• Translating Partner and client requests into specifiable analytic questions, including determining what can and cannot be answered with the data available and raising that early rather than late.
• Developing FWA analytics end to end, building the analytic logic in SQL and Python against billions of claim records, testing it, and refining it in collaboration with FWA Subject Matter Experts until it identifies something real.
• Separating genuine aberrancy from patterns fully explained by legitimate clinical practice, coverage policy or claim edits, recognizing that the mundane explanation is usually the correct one and that finding it before a Partner does is part of the work.
• Documenting methodology, assumptions and data lineage so that each analytic can be reproduced and incorporated into the TTP analytic suite by another team without the original analyst present.
• Documenting findings and present results to internal stakeholders, and will participate in Partner discussions to clarify analytic requirements.
• Managing several concurrent requests against firm deadlines within a queue driven by Partner and client demand.

What you'll need to succeed:

• Bachelor's degree in a quantitative or health-related field, or equivalent hands-on experience.
• 4+ years writing SQL against large relational data, including CTEs, window functions and multi-table joins at scale, with enough performance awareness to understand why a query is slow.
• Working proficiency in Python for data analysis, producing clean and reproducible analysis code (pandas or equivalent).
• Demonstrated ability to turn an ambiguous request into a defined analytic question, including recognizing when a question cannot be answered with the data at hand.
• Experience documenting analytic work such that another person can reproduce it, and evidence of having come up to speed quickly in an unfamiliar data domain.
• Ability to explain analytic results clearly, in writing and in conversation, to audiences who are not analysts.
• Accuracy, attention to detail and the organizational discipline to carry several concurrent requests without dropping any.
• US citizen or Permanent Resident
• Must be able to obtain/maintain Public Trust

Desired qualifications:

• Experience with healthcare claims data (Medicare, Medicaid or commercial) and healthcare coding systems (e.g., ICD-10, CPT, HCPCS, DRG).
• Exposure to fraud, waste and abuse, program integrity, payment integrity or utilization review work.
• Experience with Snowflake and SnowSQL, or a comparable cloud data warehouse.
• Version control (Git) and collaborative code review practices.
• Familiarity with payer coverage policy (LCDs, NCDs, private carrier medical policies) and common industry claim edits (e.g., NCCI).
• Experience using Tableau or other data visualization software.

What GDIT can offer you:

• The GDIT HFPP Trusted Third Party is the only data warehouse of its type anywhere, bringing many billions of healthcare claims from dozens of public and private payers together solely for fraud, waste and abuse analytics. The cross-payer visibility it provides exists nowhere else.
• Direct daily working contact with FWA Subject Matter Experts, Business Intelligence Developers and Data Scientists on a small, fully remote, multi-disciplinary team where analytic work reaches the people who act on it.
• Competitive pay and benefits, flexible work schedule, collaborative inter-disciplinary environment where the best idea wins.

The likely salary range for this position is $76,500 - $103,500. 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. Our Identity Verification Process: As part of the hiring process, we will ask you to complete an identity verification process that leverages advanced biometrics and artificial intelligence to ensure authenticity and protect against identity fraud. You are expected to be on camera during virtual interviews. We reserve the right to take your picture to verify your identity and prevent fraud. By proceeding, you authorize the collection, processing, and use of your biometric data for identity verification and security purposes.