Job Description
Innova Solutions is immediately hiring for a part time Medicaid Data Analytics and Fraud Abuse SME
Position type: Part time (20 hours a week) / Contract
Duration: 1 year, extendable long term
Location: 100% remote
Our client is seeking an experienced Medicaid Data Analytics and Fraud Abuse SME with deep expertise in Medicaid Data Warehousing, Analytics, Federal Reporting, Fraud Abuse, and Case Management systems. This position directly supports the client’s Medicaid program.
As a Medicaid SME and Advisor, you will be providing expertise and recommendations on strategies for monitoring and continually improving Medicaid data management and analytics solutions. You will be responsible for facilitating market assessments and completing alternative market scans. The areas of expertise DHHS is seeking includes but are not limited to – Data Handling and Management, Data Reporting, Federal Reporting, Program Integrity Algorithms, Provider Fraud Abuse and Reporting, Encounter Processing, and Investigative Case Management.
Additionally, you will be responsible for analyzing business processes, identifying areas for improvement, and developing and implementing new solutions that align with business goals. You will collaborate with business and IT stakeholders (both internal and external to the organization) to gather requirements, define project scope, and ensure that project deliverables meet quality standards. You will also be responsible for monitoring and assessing the effectiveness of existing business systems and identifying areas for optimization.
Job Responsibilities:
- Serve as the subject matter expert in Medicaid data reporting and analytics.
- Provide expert level advice on Medicaid Data Warehouse enhancements and Case Management Systems, applying industry best practices.
- Facilitate market assessments, and complete alternative market scans for data analytics, investigative case management products and solutions.
- Conduct business process analysis and identify opportunities for optimization and automation.
- Actively engage with internal business/technical teams to ensure improvement of data analytics, program integrity reporting, federal reporting, fraud abuse reporting, investigative case management, and data warehouse management.
- Understand State Medicaid policies/processes to carry out research and analysis, support writing business requirements documents, preparing use cases, user stories, test cases and testing out the enhancements.
- Work with the state and state partners to identify opportunities to implement new standard methods and improve current methods of Medicaid reporting and analytics.
- Collaborate with cross-functional teams to design and implement new solutions that meet business requirements, including system integrations, data migrations, and customizations.
- Develop and maintain project artifacts including but not limited to requirements documents, process flows, data mapping, fit-gap analysis.
- Monitor and assess the effectiveness of existing business systems and identify opportunities for optimization, including system performance, data quality, and user adoption.
- Provide advice and support to end-users of business systems to ensure proper use and adoption.
- Work with stakeholders at every level of the organization to prepare recommendations and detailed plans for improving Medicaid data reporting and ensuring compliance with federal and state regulations.
- Develop and maintain documentation for business systems, including transition plans, and standard operating procedures.
- Provide support for the identification and resolution of the root cause for systemic reporting error trends.
- Help business and leadership team with problem definition.
The ideal candidate will have:
- Bachelor’s degree and fifteen (15) or more combined years in a public healthcare system, business operations, and/or the healthcare consulting industry.
- Ten (10) or more years of progressively responsible work experience in health or human services data analytics, program integrity reporting, case management systems, and data warehouse implementations.
- Ability to assess, analyze and complete market scans of alternative products and solutions.
- Progressively responsible work experience in consulting or operational experience in health care is required.
- Ability to interact professionally with clients and other outside audiences.
- Strong analytical and problem-solving skills are required; experience in quantitative program and data evaluation is highly desirable.
- Experience with Medicaid Program Integrity investigative processes and techniques is required. Additionally, experience in Medicaid data analytics and reporting is strongly desired.
- Advanced experience in federal, state, or private data analytics and user implementations is strongly desired.
- Analysis and problem-solving skills to resolve operational problems and improve reporting performance.
- Excellent oral and written communication skills, including relaying complex technical terms in an easy-to-understand manner.
Qualified candidates should APPLY NOW for immediate consideration! Please hit APPLY to provide the required information, and we will be back in touch as soon as possible.
PAY RANGE AND BENEFITS:
Pay Range*: between $70/hour and $85/hour
*Pay range offered to a successful candidate will be based on several factors, including the candidate’s education, work experience, work location, specific job duties, certifications, etc.
Benefits: Innova Solutions offers benefits( based on eligibility) that include the following: Medical & pharmacy coverage, Dental/vision insurance, 401(k), Health saving account (HSA) and Flexible spending account (FSA), Life Insurance, Pet Insurance, Short term and Long term Disability, Accident & Critical illness coverage, Pre-paid legal & ID theft protection, Sick time, and other types of paid leaves (as required by law), Employee Assistance Program (EAP).
ABOUT INNOVA SOLUTIONS: Founded in 1998 and headquartered in Atlanta, Georgia, Innova Solutions employs approximately 50,000 professionals worldwide and reports an annual revenue approaching $3 Billion. Through our global delivery centers across North America, Asia, and Europe, we deliver strategic technology and business transformation solutions to our clients, enabling them to operate as leaders within their fields.
Recent Recognitions:
- One of Largest IT Consulting Staffing firms in the USA – Recognized as #4 by Staffing Industry Analysts (SIA 2022)
- ClearlyRated® Client Diamond Award Winner (2020)
- One of the Largest Certified MBE Companies in the NMSDC Network (2022)
- Advanced Tier Services partner with AWS and Gold with MS
Website : https://www.innovasolutions.com/
Innova Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any other status protected by the statutes, rules, and regulations in the locations where it operates. If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment, please contact us at hr@innovasolutions.com or (770) 493-5588. Please indicate the specifics of the assistance needed. Innova Solutions encourages all interested and qualified candidates to apply for employment opportunities. Innova Solutions (HireGenics/Volt) does not discriminate against applicants based on citizenship status, immigration status, or national origin, in accordance with 8 U.S.C. § 1324b.
The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance Initiative for Hiring Ordinance, and other applicable laws.