Senior Health Care Analyst (Audit & Data)

#LI-HW1 #LI-Hybrid

Essential Functions and Primary Duties Develop an in-depth understanding of Medicaid and other payer regulations, including billing manuals and reimbursement policies. Conduct research to ensure compliance with billing and coding standards. Conduct audits related to Medicaid and healthcare reimbursement, focusing on the identification of fraud, waste, and abuse. Present well-researched and documented findings to clients. Use SQL to independently review and analyze large datasets of healthcare provider claims. Identify complex patterns of overpayments, underpayments, or fraud in accordance with applicable healthcare policies. Draft thorough and detailed reports and provider notification letters based on your data analysis, outlining key findings and recommendations for corrective actions. Collaborate closely with managers and clients to execute data-driven projects. Take ownership of key project tasks, manage timelines, and ensure deliverables are completed with a high degree of accuracy and professionalism. Participate in client meetings. Engage with clients and providers to explain findings and recommendations in a professional manner. Handle questions about project results or data and communicate effectively to maintain strong client relationships. Work alongside and mentor junior staff members by sharing best practices in data analysis and project management, while maintaining high standards of accuracy and confidentiality. Additional responsibilities as assigned Preferred Qualifications: Master’s degree in Health Information Administration, Health Informatics, Healthcare Management, Data Science, or related field SQL proficiency is strongly preferred, with experience in working with large healthcare datasets. 3-5 years of experience in healthcare data analysis, project execution, or related fields. Strong written and verbal communication skills, with experience in client-facing roles and report writing. Organized, detail-oriented, and able to independently manage multiple projects and deadlines. Knowledge of healthcare data privacy regulations. Certifications such as CFE, AHFI, CHDA, CPMA, RHIT, or RHIA. Experience in data mining, statistical analysis, or fraud detection methodologies. Experience working with Medicaid or other government healthcare programs.

Minimum Qualifications Bachelor's degree in accounting or related field required