The Office of the Attorney General is looking to solve the problem of Medicaid fraud and patient abuse by leveraging data science to identify, analyze, and report on fraudulent activities.
Requirements
- Create advanced fraud analysis procedures to extract, categorize, monitor, manipulate, and organize data.
- Utilize moderate to advanced skills in data analysis software to create workflow programs, import data, and perform high-level analyses.
- Independently evaluate patterns in data to explain variances in utilization and practice patterns.
- Perform advanced mathematical calculations to solve problems.
- Use logic to analyze or identify underlying principles, reasons, or facts associated with information or data to draw conclusions.
- Perform statistical sampling, modeling, and analysis techniques.
- Compile, code, categorize, calculate, tabulate, audit, verify, or process information or data.
Responsibilities
- Develops and implements a set of techniques or analytics applications to transform raw data into meaningful information using data-oriented programming languages and visualization software.
- Applies data mining, data modeling, natural language processing, and machine learning to extract and analyze information from large structured and unstructured datasets.
- Visualize, interpret, and report data findings.
- Create dynamic data reports.
- Utilizes the data warehouse to mine data and identify potentially fraudulent billing practices.
- Documents issues with the data warehouse and communicates those issues effectively to the appropriate parties.
- Categorizes, stratifies, and assigns priorities to risk factors for providers.
Other
- Reports total recoveries for the Medicaid Program resulting from data mining.
- Designs detailed analysis, summarizes findings, and communicates effectively to management and other staff.
- Provides day-to-day monitoring and tracking of assigned data mining activities and resulting case outcomes.
- Independently finds solutions to problems.
- Works with members of a multi-disciplinary team to investigate and litigate fraudulent practices.
