Data Analytics Lead

Introduction
At IBM we know that transformation drives change and it is in our DNA to continuously transform. Our Business Transformation Consultants help drive large scale change that spans IBM business units and geographies. As a part of this team you will have the unique opportunity to be a part of driving IBM’s ongoing transformation as a company that continuously innovates and leads the market.

Your Role and Responsibilities
The Data Analytics Lead is responsible for oversight of IBM Watson Health’s Iowa Medicaid Enterprise Program Integrity Data Analytics team. The Data Analytics Lead is responsible for designing and accurately completing a series of program integrity analytics used to identify and recover healthcare overpayments identify managed care overpayment and underpayment issues and benefit compliance issues. The Data Analytics Lead may also support the development of analytics focused on analyzing the quality of care received by Iowa Medicaid beneficiaries.

Essential Responsibilities

• Work closely with the client and project team to develop and implement an annual analytic work plan.
• Formally create enhance and document policies and procedures as they relate to algorithm creation and completion.
• Consistently examine progress against plan and prioritize schedules ensuring analytic deliverables are completed timely and annual fiscal goals are met or exceeded.
• Oversee the design application interpretation documentation and presentation of all comprehensive fraud waste and abuse algorithms.
• Design execute and present complex analysis as a member of the analytic team.
• Provide feedback and detailed review for all deliverables (algorithm programming algorithm write-ups letters etc.) to guarantee deliverables are reliable and completed accurately.
• Lead supervise train and coach internal analytic team with a customer-centered approach and attitude.
• Facilitate effective weekly/bi-weekly analytic team meetings.
• Address or delegate all ad-hoc data requests. Monitor progress and present details and recommendations to allow committee to decide on next steps.
• Manage referrals to audit and investigation team and track provider case progress and needs.
• Document the potential return on investment and/or recoveries for the client based on data analysis efforts.
• Develop tools reports and processes to effectively track cost avoidance.
• Build and maintain data scripts and tools to further automate Fraud and Abuse Detection System (FADS) processes.
• Participate in all relevant FADS meetings such as audit committee meetings and management meetings.
• Function as a consultant for upgrading and utilizing the case management system and its reports.
• Serve as analytic resource and liaison between data management teams project management technical teams and analytic staff of proprietary systems.
• Coordinate support for FADS client users of proprietary systems including training and fielding ad-hoc questions.
• Manage quarterly provider profile reports identifying aberrant billers and peer group outliers.
• Work with leadership and sales staff to support future contract/business proposals.
• Assist in daily management tasks for entire FADS team including personnel staffing technical financial goal-setting and other office-related issues.
• Stay abreast with modifications made to claims processing systems or data warehouses by working with contractors to understand problems and propose solutions.
• Work in partnership and support additional sub-contractors e nsuring they are performing consistently with contract expectations and addressing any issues that may arise.

Required Technical and Professional Expertise

• 5+ years of experience applying healthcare analysis methods and measures utilizing basic statistical methods.
• Experience in data evaluation database development.
• Prior experience with health care claims provider relations program integrity fraud and abuse.
• Experience leading in a fast-paced goal oriented environment.
• Experience developing policies procedures processes and workflows.
• Excellent oral and written communication skills.
• Demonstrated ability to convey complex ideas in an easily understood manner to aid audience through written or verbal communications.
• Demonstrated ability to understand industry issues and problems relate them to clients’ needs and propose appropriate solutions.
• Willingness to spend time working onsite with the client.
• Demonstrated ability to work closely and collaboratively with a client.
• Experience using analytic software such as SQL PowerBI Cognos Business Objects Tableau ArcGIS SAS Python R etc.
• Customer location is in Des Moines Iowa. This role will have to be onsite at the client location in Des Moines Iowa
• Only Iowa residents

Preferred Technical and Professional Expertise

• 2-3 years State or Federal government experience either as employee or contractor.
• Demonstrated project management organization and prioritization skills.
• 2-3 years auditing experience.
• Experience using IBM’s analytic software DataProbe
• Direct interaction with Medicaid or Medicare claims processing systems.
• Knowledge of ICD CPT HCPCS NDC & DRG code sets
• AHFI CFE or CPC certifications