Sr. Fraud, Waste, and Abuse Data Analyst
Tasks
- Analyze Medicaid claims and billing datasets
- Apply revenue cycle context to billing anomalies
- Build and validate fraud detection models
- Collaborate on feature engineering and model validation
- Conduct proactive program integrity data analysis
- Design fraud detection dashboards and alerting systems
- Develop detection queries and analytical logic
- Document methodologies for compliance and audit readiness
- Identify fraud waste and abuse patterns and anomalies
- Operationalize AI driven detection logic
- Present findings to Medicaid agencies and managed care organizations
- Translate analytical findings into product and engineering requirements
Perks/Benefits
Skills/Tech-stack
Anomaly Detection | CPT | Claim adjudication | Claims submission | Clustering | Data Modeling | Data Visualization | Dataset analysis | Denial Appeals | EVV) | Electronic Visit Verification | Feature Engineering | Fraud Detection | Generative AI | HCPCS | Healthcare revenue cycle | Language Processing | Large dataset | Large dataset analysis | Machine Learning | Managed care | Medicaid billing | Medicaid managed care | Model Validation | Natural Language | Natural Language Processing | Payment integrity | Predictive Analytics | Predictive Risk Scoring | Program integrity | Provider credentialing | Remittance | Revenue Cycle | Risk scoring | SQL | Upcoding Detection
Education
N/A
Roles
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