General Professional IV (Med-Quest Data Analyst) - Ewa, Oahu
About The Position
The General Professional IV independently performs complex professional work which involves considerable research and analysis of a variety of issues, identification of various options and recommendation of the most viable solution. This position is located in the Department of Human Services, Med-QUEST Division (MQD), Finance Office, and is responsible for conducting data analysis in support of the Division's statewide surveillance and utilization control program of program integrity functions to identify potential fraud and abuse by Medicaid program providers. The duties and responsibilities of this position include analyzing and evaluating surveillance and utilization review subsystem reports, providers' records, claims and other related materials, current trends in provider abuse and fraud, complaints against providers, etc., to determine the scope, parameters and variables for data analyses; analyzing and interpreting any identified anomalies, aberrancies, outliers, etc., and verifying or corroborating with data, records, claims, files, program providers, etc., to determine whether the utilization of services and providers' claims and billings represent potential fraud and abuse; referring cases involving possible fraud and abuse for preliminary investigation by MQD investigative staff; preparing summaries and reports with data; maintaining accurate and updated fraud and abuse reports, records, and referrals; and performing other related duties as assigned.
Requirements
- Bachelor's degree from an accredited four-year college or university.
- One (1) year of responsible professional work experience which required a high degree of analytical skill. Such experience must have involved gathering, evaluating and analyzing facts and other pertinent information required to resolve problems and/or to determine and recommend appropriate courses of action; demonstrated the ability to elicit information orally and in writing; reading, comprehending, interpreting and evaluating technical subjects, analysis or proposals; and applying problem solving methods and techniques, such as defining and analyzing problems, identifying alternative courses of action, using judgment in determining appropriate alternatives; and preparing clear and concise written reports and recommendations for action.
- The experience must have been comparable to the General Professional III in the State service and must have provided the knowledge, skills and abilities required to perform the duties and responsibilities of the position to be filled.
- At least one (1) year of General Experience must demonstrate the knowledge and skills of data analysis such as using data mining, data or database queries, statistically valid samplings, etc., of information or data such as health care providers' billings, diagnosis codes, procedural codes, health care provider information, etc.; statistical and quantitative analysis methods to determine cause and effect; computer applications including data analysis and statistical applications (e.g., LexisNexis Intelligent Investigator, IBM Cognos, SAS, Access, Excel, etc.); and the skill to interpret and summarize such data, information and findings; prepare clear and concise reports of findings; and organize large data sets with accuracy and attention to detail.
Nice To Haves
- Supervisory aptitude rather than actual supervisory experience may be accepted. This requirement will be considered to have been met when there is strong affirmative evidence of the necessary supervisory abilities and/or potential.
Responsibilities
- Analyzing and evaluating surveillance and utilization review subsystem reports, providers' records, claims and other related materials, current trends in provider abuse and fraud, complaints against providers, etc., to determine the scope, parameters and variables for data analyses
- Analyzing and interpreting any identified anomalies, aberrancies, outliers, etc., and verifying or corroborating with data, records, claims, files, program providers, etc., to determine whether the utilization of services and providers' claims and billings represent potential fraud and abuse
- Referring cases involving possible fraud and abuse for preliminary investigation by MQD investigative staff
- Preparing summaries and reports with data
- Maintaining accurate and updated fraud and abuse reports, records, and referrals
- Performing other related duties as assigned
Benefits
- PUBLIC SERVICE LOAN FORGIVENESS (PSLF) PROGRAM
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
