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Senior Data Integrity Analyst

at HMSA

Posted: 10/9/2019
Job Reference #: 5000541769606
Keywords:

Job Description

Employment Type

Full-time

Exempt or Non-Exempt

Exempt

Job Summary

Responsible for the maintenance, quality control, and administration of the Special Investigation Unit (SIU) data integrity and systems for FWA allegations, cases and associated record management. Produce accurate and timely reports for federal, state, employer group and HMSA senior management in accordance regulatory technical specifications. Analyze, interpret and present FWA data to internal and external investigators, management and regulatory entities.

Minimum Qualifications

  1. Bachelor's Degree and two (2) years of related work experience; or an equivalent combination of education and related work experience.
  2. Strong verbal and written communication skills.
  3. Fundamental awareness of Fraud, Waste and Abuse.
  4. Knowledge in structured query language (SQL).
  5. Knowledge of health care industry trends.
  6. Knowledge of basic relevant statistical analyses.
  7. Proficiency in issues identification and data collection, analysis, and interpretation..
  8. Proficiency in Microsoft Office applications.

Duties and Responsibilities

  1. SIU Reporting:
    • Create and generate monthly, quarterly and annual reports using data tools, queries and programming to meet the requirements of Management, the Association, Federal, State and other regulatory entity technical specifications for Fraud, Waste, and Abuse reporting.
    • Produce, analyze and present ad hoc reports for internal and external investigators. 
    • Provide quality control, critical thinking and problem solving to produce accurate, timely and formal reporting on behalf of the Special Investigations Unit and HMSA.
  2. SIU Data Integrity:
    • Manage the overall data analysis program for Fraud, Waste and Abuse and provide quality control to case data managed by SIU.
    • Suggest and implement opportunities to improve data integrity, reporting and analysis for the Special Investigations Unit.
  3. Data Analysis and Presentation:
    • Prepare and present analyses and summaries for proactive FWA cases. Generate, analyze and formalize data needs for law enforcement, federal, state and management upon request; present as applicable. Document and present methodology used to generate data and reporting.
  4. Maintenance and Evaluation of Data Analysis Tools and SIU Tracking Systems:
    • Provide oversight and perform maintenance of the various technology tools used by Special Investigations Unit to generate reporting and perform data analysis.
    • This includes maintenance of FWA allegation and case management system as well as other tools that may be incorporated into SIU's daily work processes.
    • Work collaboratively with SIU staff and outside vendors to address data or system issues that may arise.
    • Assess and evaluate new tools and products, participate in the implementation of new technology/ tools to combat fraud, waste and abuse, and coordinate efforts to master, test and apply the new technology.
  5. Perform other duties as assigned.