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CareSource

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

Program Integrity Data Scientist II

Data ScientistData ScientistOtherRemoteSeniorTeam 1,001-5,000Since 30+ yearsH1B SponsorCompany SiteLinkedIn

Location

United States

Posted

82 days ago

Salary

$83K - $132.8K / year

Seniority

Senior

Bachelor Degree3 yrs expExperience acceptedEnglishAWSAzureGCPPythonSQL

Job Description

Program Integrity Data Scientist II

CareSource

• Develop, implement, manage, and deploy in-depth analyses for payment accuracy, anomaly detection, and Fraud, Waste, and Abuse (FWA) • Build concepts as algorithms to identify claims for pre- or post-pay intervention based on probability of fraud, waste, and abuse • Analyze and quantify claim payment issues and provide recommendations to mitigate risks • Identify trends and patterns using processes, tools, reports, and databases • Conduct outcome analyses to determine impact and effectiveness of initiatives • Collaborate on the examination and explanation of complex data relationships • Monitor and provide explanation of anomalies related to trends associated with potential Fraud Waste and Abuse • Collaborate with Legal Department to support proceedings • Develop hypothesis tests and extrapolations on statistically valid samples • Communicate results and ideas to key stakeholders • Prepare code for operationalization of end-to-end model pipeline

Job Requirements

  • Bachelor's degree in Data Science, Mathematics, Statistics, Engineering, Computer Science, or a related field required
  • Equivalent years of relevant work experience may be accepted in lieu of required education
  • Three (3) years data analysis and/or analytic programming required
  • Experience with cloud services (such as Azure, AWS or GCP) and modern data stack (such as Databricks or Snowflakes) preferred
  • Healthcare experience required
  • Proficient in SQL and at least one of the following programming languages: Python / R / RAT STAT
  • Familiarity with SAS is preferred
  • Ability to perform advanced statistical analyses and techniques including t-tests, ANOVAs, z-tests, statistical extrapolations, non-parametric significance testing, and sampling methodologies
  • Working knowledge of predictive modeling and machine learning algorithms such as generalized linear models, non-linear supervised learning models, clustering, decision trees, dimensionality reduction and natural language processing
  • Proficient in feature engineering techniques and exploratory data analysis
  • Knowledge of healthcare coding and billing processes, including CPT4, HCPCS, ICD-9, DRG and Revenue Codes preferred.

Benefits

  • Comprehensive total rewards package
  • Bonuses tied to company and individual performance

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