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data analysis sql machine learning fraud detection dashboards📋 Description
- Analyze Medicaid claims, visits, and billing data using SQL and analytics tools.
- Detect fraud, waste, or abuse patterns such as overlaps and inflated billing.
- Develop scalable detection queries across datasets.
- Apply AI/ML techniques for fraud detection and anomaly scoring.
- Collaborate with product and engineering to translate findings into requirements.
- Present insights to stakeholders and advise on detection methods.
🎯 Requirements
- 5-7 years in healthcare analytics, payment integrity, or related field.
- Strong SQL proficiency for large datasets.
- Experience identifying patterns or anomalies in healthcare claims.
- End-to-end revenue cycle knowledge: submission, adjudication, remittance, denials.
- Medicaid billing knowledge: HCPCS, CPT, 837P/837I and related rules.
- Familiarity with federal Medicaid regulations (42 CFR Parts 431, 447, 455) and CMS oversight.
🎁 Benefits
- Health plans and comprehensive benefits.
- Paid time off and company holidays.
- 401K with company match.
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