(765) Data Analyst (Healthcare Fraud)

Job Overview

Company Summary 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.

Job Description

The War Room protects Veterans and taxpayer dollars through data analytics, fraud risk assessment and fast administrative action, in line with Executive Orders 14395 and 14243.

The Data Analyst (Healthcare Fraud) is Essential Personnel on the fraud, waste and abuse (FWA) analytics team.

Working under the Analytics and Technology Program Director and the Senior Data Analyst, this person uses VA's Palantir analytics and workflow platform to analyze VHA claims, enrollment and exclusion data.

This includes supporting the Provider 360 view of community care providers, anomaly detection and network analysis to find coordinated billing schemes. The role is advisory and analytical. All final decisions stay with Government personnel.

Key Responsibilities

• Company Summary Arlo Solutions (Arlo) is an information technology consulting services company that specializes in delivering technology solutions.
• 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.
• Position Arlo Solutions is supporting the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Office of Integrity and Compliance (OIC) in standing up and running the VHA Fraud Rapid Response Center ("VA War Room").
• The analyst builds and tests business rules that detect potential fraud and overpayments, and surfaces anomalies and prioritized leads for OIC review.
• This includes supporting the Provider 360 view of community care providers, anomaly detection and network analysis to find coordinated billing schemes.
• Location: Remote with On-Site Requirements Clearance: Public Trust Responsibilities and/or Success Factors: 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.

Required Skills and Qualifications

• Documentation & Knowledge Transfer: Document rule specifications, acceptance criteria and analytic methods.
• Minimum Qualifications Including Certificates: 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 Desired Qualifications: 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 AAP Statement 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.

Work Location and Schedule

This role is listed as Remote USA with location information shown as Remote USA. The employment type is Full Time.

About the Company

Arlo Solutions is the organization connected with this listing. USA Jobs Today displays this opportunity for job discovery only, so applicants should verify company details, application instructions, and eligibility on the official employer website.