Responsibilities for the Data Analyst (Healthcare Fraud) include:
- Develop, test, and maintain analytical business rules and fraud detection algorithms to identify healthcare fraud, waste, and abuse (FWA).
- Analyze healthcare claims, provider, and enrollment data to identify suspicious billing patterns, improper payments, overpayments, and high-risk providers.
- Build and support data pipelines, workflows, dashboards, and reporting solutions using analytics platforms and visualization tools.
- Perform anomaly detection, provider risk scoring, and network analysis to support fraud investigations and case prioritization.
- Document analytical methodologies, support quality assurance efforts, and create executive-level reports, briefings, and recommendations.
- 2-5 years of experience supporting healthcare data analytics, fraud detection, payment integrity, healthcare claims analysis, or related federal healthcare initiatives.
- Strong technical experience with SQL, Python, and data analytics platforms, including data pipelines, transformations, and dashboard development.
- Experience analyzing healthcare claims data, provider information, CPT/HCPCS codes, ICD-10 codes, beneficiary data, and fraud detection methodologies.
- Bachelor's degree in Information Technology, Computer Science, Data Science, Statistics, Health Informatics, or a related field.
- Ability to pass a Tier 2 / Moderate Background Investigation (MBI) and obtain a VA Personal Identity Verification (PIV) card.
Salary Range: $100,000 - $110,000 depending on experience
Full Benefits Package: PTO, Paid Holidays, Medical, Dental, Vision, 401K, Sick Leave as required by law
Keywords
Data Analyst, Healthcare Fraud Analyst, Fraud Detection Analyst, Healthcare Data Analyst, Healthcare Analytics, Fraud Waste and Abuse, FWA Analyst, Payment Integrity Analyst, Improper Payments Analyst, Federal Healthcare Analytics, Healthcare Claims Analysis, VA Healthcare, Veterans Health Administration, VHA, Medicare Analytics, Medicaid Analytics, Healthcare Fraud Prevention, Provider Risk Scoring, Provider 360, Data Analytics, SQL Developer, Python Develope
