Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for under-served communities.
We have an exciting opportunity for a data analyst with healthcare experience or a recent Master’s graduate with SAS experience to join our Easton MD based I-MEDIC RFI team. This is a full-time regular position with excellent benefits. The preferred location for this position is Qlarant's Easton MD headquarters located about 1.5 hours southeast of Washington, DC and Baltimore.
This position on the MEDIC Request for Information (RFI) team extracts and analyzes data in response to requests from internal and external customers. Internal customers include investigators, pharmacists and medical review staff who are evaluating potential fraud cases for referral to law enforcement. External customers include law enforcement agents (DOJ and OIG) and CMS who are investigating Medicare fraud, waste and abuse.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
- Discuss the requirements of the RFI with the customer, assisting to define the most appropriate type of analysis and report format to address the allegation.
- Identify the most appropriate source of data and recommend the methodology for analysis, consulting with Subject Matter Experts (SMEs) as needed.
- Extract Medicare claims and Prescription Drug Event (PDE) records from the CME Integrated Data Repository (IDR) using various interfaces.
- Utilize additional databases to supplement the information available in the claims data.
- Analyze the data and prepare reports using SAS, SAS EBI, and Excel. For ad hoc requests, you will use SAS and/or Excel to complete analysis and prepare reports.
- Participate in projects involving a multidisciplinary team.
- Trend data to identify potential opportunities (e.g., variances, significant outliers, percentile ranked groups) for quality improvement or focused investigations.
- Aid in design data analysis strategies to identify potential areas for quality improvement or focused investigation.
- Analyze data, draw conclusions, and summarize into quality indicator values
- Develop tabular and graphical presentations of data, which clearly and concisely illustrate current levels of care.
- Populate tabular and graphical presentation of data.
- Contribute to the development of interventions (i.e., develop educational materials for doctors and nurses) which will improve healthcare processes and outcomes.
- Facilitate design re-measurement strategies (after intervention) of healthcare processes and outcomes to effectively quantify impact of interventions for improvement.
- Analyze re-measurement data and summarize into quality indicator values.
- Support development of reports concerning all of the above.
- May mentor junior Data Analysts in technical aspects of their work.
- Assist in preparing findings for publishing in peer reviewed journals.
- Familiar with commonly used concepts, practices and procedures, relying on instructions and pre-established guidelines to perform the functions of the job.
To perform the job successfully, an individual should demonstrate the following competencies:
- Analytical- Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data.
- Problem Solving- Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions.
- Judgment- Exhibits sound and accurate judgment; Supports and explains reasoning for decisions.
Other Skills and Abilities
- To perform this job successfully, an individual should have fluency in SAS or other statistical programming software and MS Office.
- Ability to work independently and in teams.
- Must possess familiarity with statistical and epidemiological methodologies, and automation techniques for analytic tasks.
- Ability to work with highly sensitive information while preserving the confidentiality of the information.
- Working knowledge of healthcare systems, Medicare/Medicaid preferred, healthcare databases and coding systems.
- Bachelor's degree (BA or BS) in Statistics, Biostatistics, Epidemiology, Public Health or related discipline (e.g., Economics, Mathematics, Engineering, Computer Science) required.
- Minimum of 2 years of hands-on SAS or other statistical programming work experience, or demonstrated combination of education and experience. A Masters degree in an appropriate field with related SAS experience will be considered an equivalent.
- 6 months experience with health related analytic research and quality improvement methodology (ISO, CQI, TQM, Six Sigma, Lean, Etc.) preferred.
Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.