(765) Data Analyst (Healthcare Fraud)

Arlo Solutions (Arlo) is an information technology consulting services company that specializes in delivering technology solutions. Our reputation reflects the high quality of the talented Arlo Solutions team and the consultants working in partnership with our customers. Our mission is to understand and meet the needs of both our customers and consultants by delivering quality, value-added solutions. Our solutions are designed and managed to not only reduce costs, but to improve business processes, accelerate response time, improve services to end-users, and give our customers a competitive edge, now and into the future. 

• →FWA Rule & Algorithm Development:
  • →Write, test and document business rules and algorithm logic mapped to FWA schemes.
  • →Support provider risk-scoring and case-prioritization criteria. 
    
    
• →Platform Development:
  • →Support configuration, code development and deployment on VA's Palantir platform, including data pipelines and system integration.
    
    
• →Provider 360 & Anomaly Detection:
  • →Help combine claims, enrollment and exclusion data into a single Provider 360 view.
  • →Support anomaly detection and network analysis. 
    
    
• →Weekly Analytic Runs:
  • →Run the weekly analytics that feed War Room decision packages and the recurring prioritized lead lists.
    
    
• →Data Extraction & Analysis:
  • →Extract, clean and analyze federal healthcare data for FWA identification.
  • →Support claim review workpapers. 
    
    
• →Quality Assurance & Back-Testing:
  • →Back-test rules, track rule precision and support QA and corrective action plans.
  • →The QASP targets at least 65% positive predictive value in month one and 70% by Day 60. 
    
    
• →Benchmarking:
  • →Support federal benchmarking and alignment of VHA data analysis with CMS data and methods.
    
    
• →Dashboards & Reporting:
  • →Build dashboards, visualizations and data for quarterly fraud trend and improper payment reduction reports, risk governance reporting and leadership briefings.
    
    
• →Documentation & Knowledge Transfer:
  • →Document rule specifications, acceptance criteria and analytic methods. Train VA staff to run War Room analytics on their own.
    
    

• Must be legally eligible to work in the United States
• Able to pass a Tier 2 / Moderate Background Investigation (MBI) and get a VA PIV card
• Bachelor's degree in information technology, Computer Science or a related field (such as data science, statistics or health informatics) 
• 2-5 years of federal healthcare data analytics experience, such as with Medicare, Medicaid or VHA data Experience writing healthcare data analytics business rules
• Strong coding skills in SQL and Python (or PySpark/R)
• Proficiency with analytics platforms, including data pipelines, transformations and dashboards
• Working knowledge of healthcare claims data, such as claim types, CPT/HCPCS and ICD-10 codes, NPIs and provider and beneficiary data
• Able to handle PHI and sensitive information under HIPAA and VA privacy requirements, and to complete the required VA TMS trainings

• Hands-on experience with Palantir Foundry or Gotham Healthcare FWA or payment integrity analytics experience, such as detecting upcoding, unbundling, duplicate billing, impossible days or excluded providers
• Experience with VA Community Care data, the CMS Integrated Data Repository (IDR), or the OIG LEIE and SAM exclusion lists Anomaly detection, machine learning or network/link analysis experience
• Rule back-testing and precision measurement experience (PPV, false-positive analysis)
• Experience with Power BI, Tableau or similar visualization tools
• Certified Fraud Examiner (CFE) or a data or analytics certification

We are proud to be an Affirmative Action and Equal Opportunity Employer and as such, we evaluate qualified candidates in full consideration without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, age, disability status, protected veteran status, and any other protected status.