Sr. Health Data Analyst - Fraud Waste and Abuse

Location
Eagan, Minnesota
Salary
Apply for details
Posted
Mar 15, 2019
Job Type
Long-Term
Hours
Full Time

The Senior FWA Health Data Analyst provides information, analyses, and consultation to internal and external stakeholders. This position assesses disparate data sets which include pharmacy and medical claims to develop recommendations for improvements or enhancement to support Fraud, Waste, and Abuse (FWA) analytics.

This position will develop new reports, analytical models, and FWA identification methods that are key in Prime’s fight against health care fraud and wasteful billing practices. Additionally, this role will lead high-complexity analysis and special projects as required.

 

Responsibilities

  • Act as a champion of the consulting and FWA analytic methodology; may provide work direction to others and serve as technical SME on FWA analytics
  • Develop analytic methodologies, models, reports and new products
  •  Lead complex analytical work efforts and leverages deep understanding of client or organizational drivers and maintains accountability for FWA analytics and ad hoc reporting
  • Proactively analyzes and builds recommendations for enhancements to surface FWA schemes
  • Leverage knowledge of understanding of pharmacy and medical claims data and reimbursement methodologies to perform data analysis, data blending, and quality monitoring
  • Minimum Qualifications

    Bachelor’s degree in Mathematics, Finance, or related field, or the equivalent combination of education and/or relevant work experience; HS diploma or GED is required

    • 5 years experience in pharmacy benefits management, reporting & analytics, benefits consulting, healthcare, financial services or other related field
    • Must be eligible to work in the United States without need for work visa or residency sponsorship
    Additional Qualifications

     

    • Advanced troubleshooting skills, including in-depth client data research, which may involve research and drivers of utilization; Understands resources needed and steps/processes on how to complete the problem; when issue arises, able to understand how to navigate to a resolution
    • Strong PBM industry knowledge and knowledge of the financial levers of Prime. Able to articulate the industry trends to clients and the impact of trends and changes to client financials
    • Ability to establish rapport and effectively influence at all levels within an organization
    • Ability to communicate effectively and present complex data to a wide variety of audiences
    Preferred Qualifications

     

    • PBM (Pharmacy Benefit Management) experience
    • Experience conducting complex analysis on large sets of pharmacy, claims, medical, and/or financial data
    • Basic to intermediate SAS coding skills
    • Previous experience in a client facing or consultative role
    • Extensive experience using analytic tools; familiarity with SAS EG
    Minimum Physical Job Requirements

     

    • Ability to travel up to 10% of the time
    • Constantly required to sit, use hands to handle or feel, talk and hear
    • Frequently required to reach with hands and arms
    • Occasionally required to stand, walk and stoop, kneel, and crouch
    • Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
    • Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
    Reporting Structure
    • Reports to Manager or Director in the Network Management, Consulting Analytics or Operations & Planning department
    Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage qualified minority, female, veteran, disabled, and other diverse candidates to apply and be considered for open positions.