Lead Data Analyst - Federal Compliance & Pharmacy Analytics

New York State Department of Health; City of Albany (NY); On-site; USD 90,000 - 130,000; Full time

Benefits offered by this job

Holiday & PTO

PSLF

NYS Pension

Shift pay differentials

Health insurance

Dental & vision

Job summary

The New York State Department of Health seeks a Data Analyst 3 to lead a unit focused on federal data compliance, pharmacy claims analytics, and audit support for CMS and OIG. You will apply advanced SQL, BI tools, and statistical methods to ensure accurate reporting and identify fraud, waste, and abuse in Medicaid claims.

Responsibilities include supervising analysts, developing data quality frameworks, and coordinating corrective actions with program areas to meet federal standards and

Qualifications

• Nine years of experience in data visualization, and statistical models and data mining tools.
• Substitution: an associate’s degree may substitute for two years; a bachelor’s may substitute for four years.
• A master’s degree may substitute for one year; a PhD may substitute for two years.

Responsibilities

• Lead and direct the activities of a unit dedicated to federal data compliance, pharmacy fraud/waste/abuse detection, fee-for-service claims analysis, and audit data support; establish unit goals, priorities, and procedures; provide guidance to staff on claims analytics, rate code interpretation, federal reporting standards, and audit response protocols.
• Conduct complex analyses of pharmacy claims data to identify fraud, waste, and abuse indicators such as aberrant prescribing, excessive dispensing, controlled substance diversion, therapeutic duplication, days-supply manipulation, billing for non-covered drugs.
• Analyze fee-for-service claims and encounter data to identify billing irregularities, rate code misapplication, pricing discrepancies, unbundling, upcoding, and reimbursement anomalies; validate claims accuracy against Medicaid rules.
• Serve as analytic resource for CMS and OIG audits; produce data extracts, conduct investigations, prepare audit documentation, reconcile discrepancies, and coordinate corrective actions.
• Oversee data submitted to CMS for federal reporting; identify data quality deficiencies and coordinate corrective actions to maintain compliance.
• Develop data quality monitoring frameworks and recurring compliance scorecards to alert management to risks and audit readiness.
• Investigate encounter submission issues; coordinate with eMedNY, PDP, and encounter intake to resolve data issues.
• Develop and implement advanced analytics for FWA investigations and fee-for-service reviews; prioritize investigations and produce actionable intelligence.
• Maintain compliance dashboards and analytic products to monitor pharmacy trends and audit findings; review and improve analytic processes.
• Review data sources and reports for accuracy and alignment with standards; mentor junior staff and ensure trend analysis across data domains.
• Perform supervisory responsibilities over Data Analysts and technical staff within the unit

Skills

Data visualization

Statistical models

Data mining

SQL

Audit support

Education

Bachelor's degree in a related field

Tools

BI tools

Job description

The New York State Department of Health seeks a Data Analyst 3 to lead a unit focused on federal data compliance, pharmacy claims analytics, and audit support for CMS and OIG. You will apply advanced SQL, BI tools, and statistical methods to ensure accurate reporting and identify fraud, waste, and abuse in Medicaid claims.

Responsibilities include supervising analysts, developing data quality frameworks, and coordinating corrective actions with program areas to meet federal standards and