Data Science & Informatics Specialist 1 | Medicaid Fraud Control Division | Olympia

State of Washington Attorney General's Office; Olympia (WA); On-site; USD 87,000 - 117,000; Full time

Benefits offered by this job

Flexible schedules

Hybrid telework options

Wellness program

Public Employees Retirement System (PE

Job summary

The State of Washington Attorney General's Office in Olympia is seeking a Data Science & Informatics Specialist 1 for the Medicaid Fraud & Abuse Division. You will analyze Medicaid data to identify fraud indicators and support investigations, using SQL queries and statistical methods.

A full-time role with competitive benefits and potential for hybrid telework, offering a salary range of $86,688 to $116,544 and a strong focus on data-driven enforcement.

Qualifications

• Bachelor's degree in informatics or related field with 1 year of data science/informatics experience.
• Experience in public health or healthcare data and data visualization is desired.
• Additional qualifying experience may substitute for education on a year-for-year basis.

Responsibilities

• Perform research, querying, and analysis of Medicaid claim data to detect fraud.
• Design and execute SQL queries to access Medicaid data.
• Assist in developing statistical models and data algorithms for investigations.
• Review billing records and medical coding to identify irregularities.
• Collaborate with senior data scientists and maintain documentation of analyses.
• Maintain reports, spreadsheets, and data visuals in electronic format.

Skills

Data analysis

Query writing

Statistical modeling

Data algorithms

Healthcare data

Education

Bachelor's degree in informatics, data science, mathematics, computer science, statistics, biostatistics, epidemiology, or related field

Tools

SQL

Excel

Job description

Position and Salary

The Attorney General’s Office is recruiting for a permanent full time Data Science & Informatics Specialist 1 in the Medicaid Fraud & Abuse Division. This position is located in Olympia, Washington, and is represented by the Washington Federation of State Employees (WFSE).

Data Science & Informatics Specialist 1 Salary Range 68: $86,688 - $116,544

The base pay offered will take into account internal equity and may vary depending on the preferred candidate’s job-related knowledge, skills, and experience.

Excellent benefits

Washington State offers one of the most competitive benefits packages in the nation, including Medical/Dental/Vision for employees & dependent(s); Vacation, Sick, and Other Leave; 11 Paid Holidays per year; Public Employees Retirement System (PERS) plans; and Life Insurance. Beyond these traditional benefits, we offer Dependent Care Assistance, Flexible Spending Accounts, Public Service Loan Forgiveness, Tuition Waiver, Deferred Compensation, Employee Recognition Leave, and more. With the goal of employee health and wellness, we also offer:

• Flexible schedules and part-time/hybrid telework options;
• A Wellness Program, an Infants in the Workplace Program, and the Employee Assistance Program, which provides counseling, webinar, and other cost-free support resources;
• Numerous employee-driven affinity groups to foster community and connection, including Bereavement, Elder Care, Parenting, POC, LGBTQ+, Veterans and more. The AGO is a place to belong and make a difference!

About the Medicaid Control Division

The work of the Office’s Medicaid Fraud & Abuse Division (MFAD) focuses on both criminal and civil law enforcement. The 75% federally funded MFAD‘s mission is combating provider fraud, abuse and neglect in residential facilities and involving Medicaid recipients in non-institutional settings.

MFAD’s Headquarters is located in Olympia, Washington with some team members also located at the AGO's Spokane Office and Seattle Office. The Division currently has a staff of 60 FTEs, including attorneys, auditors, special agents, data analysts, clinical health investigators and professional support staff.

MFAD involves protecting not only the Medicaid program of roughly 13 billion dollars per annum, but also its most vulnerable persons, typically elderly persons in residential facilities or persons abused or neglected by a Medicaid Provider. In many of our cases, there is no precedent so MFAD is consistently on the cutting edge of legal theories and issues. The cases range from abuse and neglect of persons in nursing homes, large scale organized individual and corporate civil and criminal fraudulent activity to national whistleblower actions. Our staff is a highly professional, fun and seasoned analytical investigative team. MFAD is unique in that all cases have an attorney, special agent, data analyst assigned with legal support. This, and the great people who make up the division, gives MFA a particularly terrific team atmosphere.

Duties and Essential Functions of a Data Science & Informatics Specialist 1

Perform research, querying, and analysis of complex Medicaid claim and encounter data; and review financial, billing and healthcare records to identify and detect trends, anomalies and patterns indicative of fraud.

• Assist in designing, writing and executing data queries utilizing SQL and other available programming language to query Medicaid data.
• Assist in the designs and implementation of advanced statistical models and data algorithms.
• Assist in investigative steps to identify, research and assess allegations of fraudulent billings and/or other issues.
• Use developed SQL queries and software applications to conduct complex quantitative and qualitative analysis to identify potential fraud schemes for case development.
• Analyze complex healthcare service claim and encounter data to determine utilization of complaint/allegation and respond to data requests.
• Research Medicaid billing and program guides, policies, state and federal regulations; payment methodologies; billed medical, dental and social services procedure and applicable modifier codes; and diagnosis codes.
• Research and understand medical coding systems and guidelines for CPT, HCPCS, ICD, DRG, EAPG, etc.; and the use and application of these codes to identify billing and coding irregularities.
• Examine, analyze and research financial and billing documents; audit documents, and healthcare records obtained during the intake process, and/or collected from search warrants and Civil Investigative Demands.
• Collaborate with senior data scientists to review analytical reports, spreadsheets, data visualizations and associated documents.
• Maintain all reports, documents, spreadsheets, correspondence and other pertinent documentation in electronic format.

There will be a full training program to assist you with becoming familiar with the data and how to query Medicaid data. If you’re looking for a great place to work with positive environment, then this is the job for you!

This recruitment announcement may be used to fill multiple open positions for the same classification, in addition to the position(s) listed in this announcement.

Required Qualifications

Bachelor's degree in informatics, data science, mathematics, computer science, statistics, biostatistics, epidemiology, or a related technical or quantitative field, and one (1) year of experience performing data science or informatics data work.

Experience working in a specialty area, such as public health or healthcare; and/or working with data visualization software and programming may be desired.

Additional qualifying experience may substitute year for year, for required education

Preferred Certification:

• Proficiency with Microsoft Excel, with the ability to develop complex spreadsheets with macros, multiple math functions, advanced filters, and links to external sources of information.
• Basic skills and experience with medical coding terminology and systems (CPT, HCPCS