Statistician - Medicaid

SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.

We are seeking a Statistician to be part of our team of professionals.  You will be part of the Southeastern Unified Program Integrity Contract (SE UPIC) audit team. The SE UPIC is responsible for audits/investigations in eight States and two Territories. The Statistician under our Medicaid Team will be responsible for conducting statistical sampling, determine overpayments, and data analysis on Medicaid Managed Care Plan’s (MCP) and evaluate whether their activities are safeguarding the Medicaid program and providing appropriate services to beneficiaries. This includes comprehensive Managed Care Organizations (MCOs), as well as Pre-Paid Inpatient Health Plans (PIHPs) and Pre-Paid Ambulatory Health Plans (PAHPs). 

What you'll do:

The Statistician requires the individual to apply statistical methodologies on Medicaid Managed Care Plan claims data and other sources of information to identify Medicaid program integrity issues.    

• This position may require the incumbent to appear in court to testify about work findings
• Analyze data to identify and compare norms, trends and patterns
• Present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
• Conduct self-directed research to uncover problems in Medicare payments made to a variety of provider types including physicians, suppliers, hospital, rehabilitation facilities, Skilled Nursing Facilities, Rural Health Care Facilities, and other healthcare professionals as well as Home Health Agencies and Hospices
• Organize case files, research violations and accurately and thoroughly document all steps taken in project development
• Estimate overpayment amounts using both parametric and non-parametric approaches
• Telework available from contiguous United States

Basic Qualifications:

• 5 years with BS/BA; 3 years with MS/MA; 0 years with PhD
• 3 years experience in data analysis (Relevant experience skills should include data analysis, statistical sampling, complex audit and/or investigative experience)
• Excellent computer skills and knowledge, including Excel, Business Objects or equivalent, and data mining/statistical analysis tools (e.g. SAS, Python, R, etc.)
• Excellent analytic and quantitative skills
• Good interpersonal skills
• Ability to use and evaluate statistical software tools
• Ability to extract, analyze, array and display data to support problem identification and case development
• Ability to communicate effectively, internally and externally
• Ability to work independently and as a member of a team to deliver high quality work
• US Citizenship Required 

Desirable Qualifications:

• Ability to organize work and systematically pursue a hypothesis through statistical techniques including regression models and interaction with subcontractors on sophisticated predictive software
• Ability to conduct self-directed research to uncover potentially fraudulent or abusive billing using a variety of data sources and analytic tools
• Ability to develop sample design and sampling plans to support fraud case development, especially with regard to overpayment estimation
• Excellent communication skills

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