This position will assist the client in its data mining and reporting efforts. Reports will be used by management to most effectively deploy the resources required to recover Medicaid dollars and/or prevent fraudulent and abusive billing practices.
The consultant must be able to:
(1) develop sophisticated data mining queries to extract information using a myriad of computer applications and query language
(2) analyze and extrapolate the data to further develop and test theories of Medicaid fraud, waste, and abuse
(3) synthesize the information into high-quality reports consisting of medical data, charts, and graphs that will be used to assign audits, conduct investigations, and support litigation.
The consultant will be responsible for working with management, users, application developers, and other staff, and must ensure HIPAA (Health Insurance Portability and Accountability Act) standards are met with respect to all facets of their work.
Experience: MANDATORY
1. A minimum of one year experience working with a data warehouse larger than 1 terabyte.
2. A minimum of one year experience writing SQL queries in a data warehouse environment.
3. A minimum of one year experience with systems that directly access New York State Medicaid claims data.
4. A minimum of five years experience as an auditor in an environment involving the processing of health claims.
5. Strong communication skills (written and verbal). A writing sample prepared by the candidate consist of the following factors: consisting of three or more pages must be provided.
DESIRABLE Experience
1. Number of years experience with fraud/investigative case management systems. information and inter-personal and communication skills.
2. Number of years experience using 'BI Query' to access data related to the New York State Medicaid program.
3. Number of years experience with health claim fraud initiatives, as demonstrated by active participation in a regional or national anti-fraud association.
4. Number of years experience in healthcare program integrity.
5. Number of years experience working with confidential data in a governmental agency (Federal or 2. NAME State) involved with the administration of a health care program.
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