Organizational Integrity Data Scientist

Job Description

Description

PeaceHealth is seeking a Organizational Integrity Data Scientist for a Full Time, Day position.

*This role will be perfect for a candidate that wants an opportunity to work with an amazing mission based organization and team that is focused on service to our patients, caregivers and the communities that we serve.

The person in this role will support compliance and organizational integrity with data programming, development, audit and more. If this sounds exciting to you come join PeaceHealth!

JOB SUMMARY

Serves as a statistics, data, and analytical expert to support the needs of, and participate in, the Organizational Integrity Department, including system-wide projects, work groups and initiatives related to PeaceHealth’s healthcare compliance, privacy and audit programs. Produces statistical, data, and analytics solutions used for high-impact compliance and audit activities within PeaceHealth. Develops SQL, ACL, and other necessary data scripts to establish and maintain an effective system of data models to provide insight into risks and to help evaluate the adequacy and effectiveness of internal controls. Analyzes and tests large datasets for trends, outliers, anomalies, and patterns. Develops, collects, integrates, analyzes and prepares analytical reports to support Organizational Integrity.

ESSENTIAL FUNCTIONS

• Develops and implements standardized workflows, algorithms, data processing scripts, and analytical tools necessary to mine, extract, filter, clean, validate and analyze PeaceHealth’s claims, reimbursement, encounter, and revenue data to support the quantitation, reporting and return of overpayments, for conducting audits, and to support other OI projects. Creates and executes ad-hoc SQL and ACL scripts and data processing routines to analyze data to support OI studies and projects related to ensuring operational compliance with a variety of regulatory requirements.
• Applies statistical and mathematical techniques to support overpayment and other analyses, including determining sample sizes, data stratification, data sampling, significance testing, confidence intervals, and appropriate data modeling. Applies RAT-STATS to determine appropriate statistical sampling and extrapolation techniques consistent with OIG guidelines.
• Works to identify data, information needs, and specific output requirements, and execute against those with the most appropriate source of data, tools for analyzing, and output format. Develops SQL, ACL, and other necessary data scripts to establish and maintain an effective system of data models to provide insight into risks and to help evaluate the adequacy and effectiveness of internal controls. Analyzes and tests large datasets for trends, outliers, anomalies, and patterns. Develops repeating scrips to support continuous audit activities. Performs audit tests of controls by obtaining and analyzing audit evidence, evaluating test results, drawing conclusions and preparing supporting audit workpapers.
• Serves as the primary data expert and reporting analyst for all information systems used by Organizational Integrity, including Navex EthicsPoint, HIPAA monitoring system, C360 Claims Audit Manager, TeamMate, Quick Base, Tableau and others. Provide support for c360 application data field alterations and troubleshooting with the vendor.
• Designs and develops Organizational Integrity operational dashboards, key performance indicators, and monthly scorecards. Delivers Organizational Integrity management reports and performance indicators on a weekly, monthly, and annual basis necessary. Develops tables, charts and graphs as necessary for enhancing interpretation and information display.
• Serves as a primary resource for determining appropriate data strategies and writing related SQL, ACL and other data scripts to extract and analyze the data to support relevant analytical projects and goals. Effectively interacts with Technology Solutions Partners (TSP), Revenue Cycle, and Finance to understand the data structure, methodology, and/or tools required to fulfill a request.
• Gathers and analyzes data from a variety of internal and external sources to proactively identify potentially high-risk coding, billing and other operational practices that may pose a compliance risk. Develops regular reports and dashboards for monitoring various operational areas to detect outliers, anomalies, and patterns that may suggest or trigger compliance concerns.
• Provides ad-hoc project data analytical support to various Organizational Integrity departmental needs (including Privacy & Integrity, Healthcare Compliance, and Internal Audit), and drafts analytical conclusions, written reports and presentations. Ensures accuracy and appropriateness of reported information.
• Provides analytical and ACL script drafting support for effectively analyzing large datasets of OIG and related provider data to ensure PeaceHealth meets regulatory requirements for screening for providers on the excluded provider databases.
• Partners with key stakeholders to identify/clarify data and reporting needs, business definitions, business rules and information specifications. Provides data interpretation, creates/maintains self-serve model, and provides recommendations to facilitate decision making.
• Presents findings of analysis both in written and verbal form to risk management and leadership, transferring understanding in a way that actionable.
• Performs other duties as assigned.

QUALIFICATIONS

EDUCATION:

• A bachelor’s degree in mathematics, statistics, actuarial science, informatics, engineering, computer science, economics, predictive analytics, management information systems or a similar discipline is required.
• Master's or Ph.D. degree in one of preceding disciplines preferred.
• Significant work experience in the application of advanced scientific statistical techniques preferred.

EXPERIENCE/TRAINING:

• Minimum of 5 years of experience developing codes, scripts and routines to perform data analysis on large data sets (including data extraction, data mapping, data mining, data validation, detecting anomalies, and validating codes/scripts).
• Proficiency in programming SQL and ACL scripts to perform in-depth data analysis is strongly preferred. Will also consider experience in similar advanced data/scripting tools including SAS, SSRS, Crystal Reports, Tableau, SAP BusinessObjects BI, Microsoft Access and Visual Basic.
• In-depth knowledge of database query and data extraction principles and architecture. Experience with EPIC’s Clarity Data Model preferred.
• Preference for experience in a healthcare setting; preferably hospital or health system- related.

LICENSE/CERTIFICATION:

• Certified Health Data Analyst (CHDA) preferred.
• Certified Professional in Health Information and Management Systems (CPHIMS), or Certified Associate in Health Information & Management Systems (CAHIMS) preferred.
• Certified Internal Auditor (CIA) or Certified Information Systems Auditor (CISA) preferred.

OTHER SKILLS:

• Understanding of advanced applied statistics and mathematics, including data stratification, data sampling, correlation-testing, probability-estimating, significance testing, developing confidence intervals, and modeling. Familiarity with conducting of extrapolation techniques consistent with OIG guidelines. Familiarity with statistical sampling applications such as “RAT-STATS” or similar applications.
• Familiarity or experience conducting overpayment analysis/estimates consistent with OIG guidelines is preferred.
• Working knowledge of internal controls and auditing techniques
• Ability to interpret data and effectively present highly sophisticated analysis and findings.
• Experience with the application of healthcare coding systems (ICD9/10, DRG, CPT), and healthcare revenue cycle processes preferred.
• Ability to write optimal SQL statements and queries from a variety of sources and create actionable, easy-to-use end user reports. Excellent mathematical and statistics skills.
• Strong skills for understanding, extracting, analyzing, trending and benchmarking of coding, billing, reimbursement, and related data.
• Strong ability to apply analytical tools, knowledge of data analysis methodologies, data mining, use of presentation software, and using communication skills to deliver results to a variety of audiences.
• Excellent verbal and written communication skills.
• Strong organizational and analytical skills.
• Ability to manage multiple priorities, projects and display flexibility in a fast paced and changing work environment.
• Strong problem solving, critical thinking, work ethic, interpersonal and relationship building skills.
• Ability to work collaboratively with all levels of leadership.
• Ability to multi-task and balance multiple demands and time frames.
• Ability to work with internal customers to interpret their needs and report data/information back in a meaningful way.
• Advanced level skills in MS Office applications, specifically Word, PowerPoint, Access and Excel.

SYSTEM PHYSICAL/COGNITIVE REQUIREMENTS:

• Work requires fairly light physical exertion from up to 65% of the time.
• Ability to lift objects weighing 30 lbs. or less.
• Work is performed under normal working conditions with adequate lighting and ventilation.
• Job duties frequently require intense concentration and attention to detail (up to 65% of work time).

See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility.  

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state, or federal laws.