Full-Time Data Analyst II

Overview:CoventBridge Group is seeking a Data Analyst II to join our Data Analysis team, focusing on emerging technologies like Python, Databricks, and Snowflake.

Position Summary: As a Data Analyst II, you will conduct evaluations and analyses of potential fraud cases, leveraging claims information and multiple data sources.

Responsibilities:

• Perform analysis of healthcare claims data using statistical and analytical methods.
• Collaborate with management, investigators, and analysts to support case development efforts.
• Apply data mining, statistical modeling, and predictive analytics to identify anomalies in Medicare/Medicaid claims.
• Validate analytical outputs and identify potential fraud, waste, or abuse.
• Communicate analytical insights to internal stakeholders and external partners.
• Respond to management requests related to CMS reporting requirements.
• Contribute to the development and delivery of training sessions on fraud, waste, and abuse detection.
• Demonstrate strong organizational skills and manage multiple tasks efficiently.
• Ensure the integrity and security of all documentation.

Requirements:

• Bachelor’s or Master’s degree in Mathematics, Statistics, Health Informatics, Data Science, or a related field.
• Minimum 2 years’ experience analyzing Medicare and/or Medicaid data.
• Minimum 2 years’ experience in SQL and Python.
• Working knowledge of SAS, Databricks, Snowflake, or Spark.
• Experience with libraries like Pandas, NumPy, Scikit-learn, or visualization tools like Seaborn, Matplotlib, Tableau, or Power BI.
• Strong understanding of healthcare claims, ICD codes, provider identifiers, and Medicare/Medicaid billing practices.
• Exceptional organizational, communication, and problem-solving skills.

Preferred Qualifications:

• Experience working with any state Medicaid agency, Medicaid Administrative Contractor, or Unified Program Integrity Contractor (UPIC).
• Experience in transitioning from SAS to more modern tools (e.g., Databricks, Snowflake).
• Familiarity with CMS reporting and fraud detection protocols.

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