Data Science Prior Authorization Reporting Lead

Role Description

The Data Science Prior Authorization Reporting Lead applies advanced statistical techniques, mathematical modeling, and specialized programming to extract actionable insights from complex health care data in support of Apple Health’s prior authorization program. The position develops data storytelling and analytics to inform policy decisions and improve health care outcomes using tools like Power BI, Tableau, SQL, R, and Python.

This position utilizes data informatics, mathematics, statistics, and specialized programming to extract knowledge from structured and unstructured health care data. As a highly experienced Data Scientist, the position’s focus is on creating advanced data analytics, applying statistical techniques, and developing data storytelling, in support of Apple Health (Medicaid) prior authorization program and to report out on trends, insights, and critical funding and policy inquiries.

This position is eligible to telework and is typically not required to report on-site. The default assigned work location of all Health Care Authority (HCA) positions is within the State of Washington. This position reports to Olympia, WA. Frequency of onsite work will vary based on business and operational needs.

All agency employees are required to report on-site in Olympia on their first and last days of employment to pick up and return state-issued equipment, regardless of telework status or location.

Duties

• Generate high quality data products from structured and unstructured data sources using programming languages such as R, SAS, SQL, M code and/or Python to write data code/query scripts.
• Lead the development of advanced algorithms, build data models, and automate data processing tasks.
• Develop complex data quality processes and metrics to ensure accurate and timely reporting to Centers for Medicare and Medicaid Services (CMS) and the Washington state legislature.
• Lead multiple complex data science projects in collaboration with internal and external partners.
• Use and oversee the use of tools such as R, Power BI and/or Tableau to develop data models and interactive visualizations.
• Ensure overall compliance with agency process and external policy and/or legal requirements while assuring accuracy and completion of analytic projects.
• Determine the best strategy for the delivery of services within the work unit to include but not limited to ensuring a balanced workload distribution between staff.
• Maintain a participatory process by involving staff in decisions affecting them.
• Mentor staff members to build their knowledge and skills as it relates to analytical techniques, agency programs, data infrastructure, processes and best practices.
• Set standards and objectives for performance and identify strategies for implementation.
• Serve as expert of the use of advanced quantitative research methods commonly used in scientific, surveillance, and/or epidemiological research to analyze and interpret data.
• Oversee and apply statistical analysis techniques to find patterns, trends, and conclusions.
• Serve as key data science technical expert for the agency, within the prior authorization team.
• Provide advice and consultation on agency data policy development and strategic recommendations.
• Review proposal plans and implementation activities for statistical analysis such as regression analysis, clustering, or time series analysis.
• Mentor journey or entry level data scientists through peer review, constructive feedback and knowledge sharing.
• Provide expert consultation on how to manage analytic barriers, opportunities and implement innovations.
• Oversee the gathering, prioritizing, and validation of data requirements.
• Provide consultation to agency leadership regarding data access, feasibility, statistical validity, etc.
• Determine resolution of complex issues, using innovated methods to solve complex technical challenges.
• Develop innovative and effective approaches to solve requestors analytics problems.
• Assess statistical approaches, tools and methods for feasibility, relevancy and effectiveness.
• Troubleshoot highly complex issues in a timely fashion and minimizes disruption of data transmission.
• Inform complex data definitions and logic models for analysis and measures.
• Oversee staff data validity checks to identify and report anomalies in the data.
• Propose and lead technical solutions, informed by health care systems knowledge.

Qualifications

• Master’s degree or higher in informatics, data science, mathematics, computer science, statistics, biostatistics, epidemiology, or related technical or quantitative field, and one (1) year of experience performing data science or informatics data work, within health care, public health, and/or behavioral health.
• Experience must include at least one (1) year working with complex analytics, data visualization software and R, SAS, SQL, M code and/or Python programming.
• Bachelor's degree in a field identified above, and three (3) years of experience performing data science or informatics data work, within health care, public health, and/or behavioral health.
• Experience must include at least three (3) years working with complex analytics, data visualization software and R, SAS, SQL, M code and/or Python programming.
• Seven (7) years of experience performing data science or informatics data work, within health care, public health, and/or behavioral health.
• Experience must include at least three (3) years working with complex analytics, data visualization software and R, SAS, SQL, M code and/or Python programming.

Requirements

• The ability to take action to learn and grow.
• The ability to take action to meet the needs of others.
• Strong analytical skills with the ability to collect, organize, analyze, and disseminate significant amounts of information with attention to detail and accuracy.

Preferred Qualifications

• Deep knowledge of medical and/or pharmacy coding such as ICD-10, Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes; health care business and systems, including health care prior authorization processes.
• Demonstrated ability to work effectively in a multi-disciplinary team, comfortable interacting technically and politically with staff members at all levels of the agency.
• Demonstrated high level of workload & project management including organization and prioritization of tasks.
• Excellent technical written and verbal communication skills, and visual story-telling through dashboards, reports, and data visualizations.
• Highly advanced experience working with large and complex data sets; advanced level SQL, R, Python, SAS or other programming skills; significant experience with data visualization using Power BI, Tableau and other similar visualization tools.

How to Apply

Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification.

• To apply for this position, you will need to complete your profile which includes three professional references and attach in separate files:
• A cover letter that specifically addresses how you meet the qualifications for this position.
• Current resume.

To take advantage of veteran preference, please do the following:

• Attach a copy of your DD214 (Member 4 long-form copy), NGB 22, or USDVA signed verification of service letter.
• Please black out any PII (personally identifiable information) data such as social security numbers. Include your name as it appears on your application in careers.wa.gov.