Data Scientist - Medicare Part C

April 2

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LivantaLLC

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Livanta LLC is a technology-enabled organization dedicated to advancing healthcare quality through innovation. It specializes in providing services to patients, caregivers, healthcare providers, and payers, focusing on improving health outcomes, navigating healthcare systems, and ensuring payment accuracy. Livanta is recognized as the largest Medicare Quality Improvement Organization and offers a range of services including quality oversight, auditing, advocacy, and data analytics to enhance patient care and safety while managing healthcare costs effectively.

Information Technology • Data Analysis • Health Information Technology and Healthcare Consulting • Performance Measurement and Data Analytics • Strategic Communications

201 - 500 employees

Founded 2004

⚕️ Healthcare Insurance

📚 Education

📋 Description

• We are seeking a highly skilled and motivated Data Scientist with expertise in Medicare Part C data to join our team. • The successful candidate will play a critical role in analyzing and interpreting complex healthcare data to support the Centers for Medicare & Medicaid Services (CMS) in detecting and preventing fraud, waste, and abuse (FWA) within the Medicare Advantage (Part C) program. • Data Analysis and Interpretation: Analyze large datasets related to Medicare Part C to identify trends, patterns, and anomalies indicative of FWA. • Conduct statistical analyses and develop predictive models to support investigations and enhance program integrity. • Utilize machine learning techniques to detect and prevent fraudulent activities. • Data Management: Collect, clean, and preprocess data from various sources to ensure data quality and integrity. • Maintain and update databases and data systems as necessary. • Reporting and Visualization: Create detailed reports and visualizations to communicate findings to stakeholders, including technical and non-technical audiences. • Present data insights and recommendations to CMS leadership and other relevant parties. • Collaboration and Support: Work closely with cross-functional teams, including policy analysts, healthcare professionals, and IT specialists, to support data-driven decision-making. • Provide technical assistance and training to team members on data analysis tools and methodologies. • Compliance and Security: Ensure compliance with all relevant data privacy and security regulations, including HIPAA. • Implement best practices for data governance and management.

🎯 Requirements

• Minimum of 3 years of experience in data science, with a focus on healthcare data analysis. • Bachelor’s degree in Data Science, Statistics, Computer Science, Applied Mathematics, or a related field. • Master’s degree preferred. • Experience in supporting data analysis within the context of fraud, waste, abuse, and investigations. • Proven experience working with Medicare Part C data. • Experience with Medicare Advantage (Part C) risk adjustment and payment model. • Knowledge of healthcare policy and regulatory environments. • Certification in data science or related fields. • Familiarity with CMS data systems and regulatory requirements. • Proficiency in programming languages such as Python, R, and SQL. • Experience with data visualization tools like Tableau, Power BI, or similar. • Knowledge of machine learning techniques and statistical modeling. • Familiarity with big data technologies such as Hadoop, Spark, and cloud platforms (e.g., AWS, Azure). • Strong analytical and problem-solving skills. • Excellent communication and presentation skills. • Ability to work independently and as part of a team. • Attention to detail and a commitment to data accuracy.