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Job Title: Medicare/Medicaid Data Analyst
Job Number:
Organization: Integrity Management Services, INC
Posted: 1/25/2019
Type: Full-Time
Classification: Epidemiology
Industry: Public/Private For Profit
Number of Openings: 1
Location: Alexandria,  VA    USA
Position Description: Integrity Management Services, Inc. (IntegrityM), a leading healthcare consulting firm in the Alexandria, VA area, is seeking at Data Analyst to join our team. The Data Analyst performs in-depth evaluation and analysis of potential fraud cases and requests for information using claims information and other sources of data. The Data Analyst supports the development of complex cases that involve high dollar amounts, sensitive issues, or that otherwise meet criteria for referral to law enforcement, recoupment of overpayment, and/or administrative action based on reactive and proactive data analysis.

Specific Tasks

Perform data analysis, data matching, statistical analysis, trending activities, and collaborative efforts that result in the detection and prevention of potential fraud, waste, and abuse within and across Medicare and Medicaid. Uses a variety of Medicare, Medicaid, and non-CMS data to perform data analysis. Works with local management, investigators, and analysts to provide reactive and proactive case development support and to fulfill law enforcement data requests. Communicates effectively with internal and external customers, including federal law enforcement officers. Validates data analysis results and analytically identifies potential fraud, waste and/or abuse situations in violation of Medicare/Medicaid laws, guidelines, policies, and regulations. Supports management requests for CMS reporting requirements. Utilizes data analysis techniques to detect aberrancies in Medicare/Medicaid claims data and proactively seeks out and develops leads and cases received from a variety of sources including CMS and OIG, fraud alerts, and referrals from government and private sources. Works with Statisticians and Sr. Data Analysts to provide proactive data analysis results with statistically high probabilities of producing case referrals to law enforcement, overpayments, and/or administrative actions. Prepares, develops and participates in provider, beneficiary, law enforcement, or staff training as related to Medicare fraud, waste and/or abuse data analysis. Maintains chain of custody on all documents and follow all confidentiality and security guidelines. Complies with and maintains various documentation and other reporting requirements as needed.

Qualifications: Qualified candidates will possess the following:

Bachelor’s degree and/or relevant work experience as a data analyst. Have high proficiency level with MS Access and MS Excel. Requires a working knowledge of SAS and/or other applications to perform various types of data analysis. Knowledge of Medicare and Medicaid rules and regulation is required. Demonstrated knowledge of various database management systems in order to input, extract or manipulate information. 2-3 years of demonstrated experience and knowledge of health care information (health claims data specifically Medicare and Medicaid, ICD-9-CM codes, physician specialty codes, pharmaceutical data including NCPDP file formats and codes, provider identifiers, etc) is required. Preferred experience with Medicare Part C and D data and demonstrated experience and knowledge of pharmaceutical data including NCPDP file formats and codes, and provider identifiers. Enthusiastic individuals who can work effectively in a dynamic environment both in a team as well as independently is a must!

All candidates MUST pass a background check and drug screening prior to employment. Local candidates preferred.

Organization Description: Integrity Management Services, Inc. (IntegrityM) is a women owned small business specializing in assisting government healthcare organizations prevent and detect fraud and abuse in their programs. With a highly professional staff of data analysts, statisticians, medical professionals, auditors, investigators, evaluators, and regulatory analysts, IntegrityM focuses on helping ensure the integrity of healthcare program regulations and policy. Services offered by IntegrityM include:

Data aggregation and claims analysis Regulatory Analysis Audits Investigations Evaluations Program compliance, oversight, and review

Contact Information:

Interested candidates should email resumes to

Closing Date: 4/25/2019
Desired Starting Date:
Contact Name: Whitney Mohr,  Medicare/Medicaid Data Analyst
Contact Location:

Contact Location:
Contact Phone:  
Contact Fax:
Contact Email:
Web Address:
How to Apply: Please submit an application here:

Additional Information:

Web Site Delete Date: 4/25/2019