Job DescriptionJob DescriptionDescription:

We are seeking a highly skilled and motivated Data Scientist with expertise in Medicare Part C data to join our team. The successful candidate will play a critical role in analyzing and interpreting complex healthcare data to support the Centers for Medicare & Medicaid Services (CMS) in detecting and preventing fraud, waste, and abuse (FWA) within the Medicare Advantage (Part C) program.

  • Data Analysis and Interpretation :
    • Analyze large datasets related to Medicare Part C to identify trends, patterns, and anomalies indicative of FWA.
    • Conduct statistical analyses and develop predictive models to support investigations and enhance program integrity.
    • Utilize machine learning techniques to detect and prevent fraudulent activities.
  • Data Management :
    • Collect, clean, and preprocess data from various sources to ensure data quality and integrity.
    • Maintain and update databases and data systems as necessary.
  • Reporting and Visualization :
    • Create detailed reports and visualizations to communicate findings to stakeholders, including technical and non-technical audiences.
    • Present data insights and recommendations to CMS leadership and other relevant parties.
  • Collaboration and Support :
    • Work closely with cross-functional teams, including policy analysts, healthcare professionals, and IT specialists, to support data-driven decision-making.
    • Provide technical assistance and training to team members on data analysis tools and methodologies.
  • Compliance and Security :
    • Ensure compliance with all relevant data privacy and security regulations, including HIPAA.
    • Implement best practices for data governance and management.

Requirements:

  • Minimum of 3 years of experience in data science, with a focus on healthcare data analysis.
  • Bachelor’s degree in Data Science, Statistics, Computer Science, Applied Mathematics, or a related field. Master’s degree .
  • Experience in supporting data analysis within the context of fraud, waste, abuse, and investigations.
  • Proven experience working with Medicare Part C data.
  • Experience with Medicare Advantage (Part C) risk adjustment and payment model.
  • Knowledge of healthcare policy and regulatory environments.
  • Certification in data science or related fields.
  • Familiarity with CMS data systems and regulatory requirements.
  • Proficiency in programming such as Python, R, and SQL.
  • Experience with data visualization tools like Tableau, Power BI, or similar.
  • Knowledge of machine learning techniques and statistical modeling.
  • Familiarity with big data technologies such as Hadoop, Spark, and cloud platforms (e.g., AWS, Azure).
  • Strong analytical and problem-solving skills.
  • Excellent communication and presentation skills.
  • Ability to work independently and as part of a team.
  • Attention to detail and a commitment to data accuracy.

Essential Skills:

  • Excellent written and verbal communication skills required. Strong statistical and data analytical ability and problem-solving skills required.
  • Ability to manage others and work as a team member by maintaining good working relationships with co-workers, management, and customers is a must.

Organizational “Fit” Considerations:

Ability to meet deadlines as assigned is crucial. Night and weekend work may be required to accomplish tasks in timeframes assigned

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