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Senior Healthcare Data Analyst

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POST DATE 8/27/2016
END DATE 1/12/2017

Myers & Stauffer LC Indianapolis, IN

Indianapolis, IN
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Mid-Career (2 - 15 years)
Bachelors Degree


Myers and Stauffer LC is a certified public accounting and health care reimbursement consulting firm, specializing in audit, accounting, data management and consulting services to government-sponsored health care programs (primarily state Medicaid agencies, and the federal Center for Medicare and Medicaid Services). We have 40 years of experience assisting our government clients with complex health care reimbursement and provider compliance issues, operate 18 offices and have 800 associates nationwide.

At Myers and Stauffer you will have a career that is rewarding on every level of the organization. We are committed to providing our employees with:
* Professional growth and development opportunities
* Educational opportunities leading to certifications
* A diverse, dynamic, and challenging work environment
* Strong leadership, communication, and feedback
* A well-balanced lifestyle, that includes personal and family time in addition to professional and networking opportunities
* Creative and innovative solutions to challenges facing our government clients

The Senior Healthcare Analyst will work with a multi-disciplinary team to identify through data analytics provider claims involving potential fraud, waste or abuse of Medicaid or other health care system funds; will review and analyze such claims to determine if overpayments or underpayments occurred in light of applicable policies; will perform reimbursement calculations to determine the amounts of such mispayments for the purpose of preparing provider notifications; and will prepare supporting documentation and reports as required.

Essential Functions:

* Independently perform various complex analyses and audits relating to Medicaid or other reimbursement-related engagements, with a focus on identification of fraud, waste, abuse or misuse of Medicaid or other payer funds
* Develop and maintain general knowledge of Medicaid and/or other payer statutes, regulations, provider billing manuals and other healthcare reimbursement policies
* Review applicable Federal and State Medicaid policies and regulations relating to healthcare reimbursement including alternate payment methodologies
* Conduct research to determine the standards applicable to billing compliance with Medicaid or other government program regulations
* Review, summarize, and apply policies and regulations to specific analyses, reviews and audits
* Perform data analytics to identify fraud, waste or abuse of Medicaid or other health care system funds
* Interpret and analyze healthcare data, to include review and analysis of medical, financial or other records, to identify inconsistencies, anomalies, abnormal billing patterns and other indicators of suspected fraud, waste or abuse (e.g. services not rendered, up-coding, un-bundling, etc.)
* Prepare and distribute analytical data reports and/or records
* Work cooperatively and constructively with team members, including mentoring, training and assisting team members as required
* Maintain security and confidentiality of all protected health information encountered in performance of duties
* Participate in client conference calls as appropriate
* Handle phone calls and e-mails from providers to answer any questions
* Evaluate business processes to identify opportunities for improvement
* Work within the defined scope of assigned projects
* Additional responsibilities as assigned


* Bachelor s degree in Health Information Administration, Accounting, Finance, Healthcare, Criminal Justice or related field required
* CPA, CFE, AHFI, RHIT or RHIA preferred
* 3 years of related experience required
* Must have strong ability to analyze data to identify issues relating to health care fraud, waste and abuse
* Knowledge of the healthcare industry; fraud, waste and abuse audit operations, and claims and payment processing preferred
* Experience in detecting and investigating health insurance fraud, waste, and abuse preferred
* Knowledge of managed care rules and regulations
* Auditing experience preferred
* Proficient use of applicable software programs, including Microsoft Office software (Excel, Word, PowerPoint, Access, etc.)
* Knowledge of and experience with SQL and report writing preferred
* Organized and detail oriented with ability to think independently and problem solve effectively
* Demonstrated ability to communicate verbally and in writing with all levels of an organization, both internally and externally
* Effectively multi-task, prioritize assignments, manage multiple deadlines
* Ability to work in a team environment
* Must be able to travel based on client and business needs

Equal Opportunity Employer committed to employment of Females, Minorities, Persons with Disabilities and Veterans. An E-Verify Employer. Drug-free workplace.

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