Healthcare Claims - Data Validation & Quality Lead - 240680

Job Title: Healthcare Claims - Data Validation & Quality Lead - 240680
Position Type: Direct Hire
Work Location: 100% Remote - EST Hours
Compensation Range: Starting at $130- $145K depending on experience (+ bonus, equity, benefits)

ABOUT OUR CLIENT + ABOUT THE ROLE

Our client is a healthcare analytics organization focused on Healthcare Claims Data and Analytics. The organization delivers insights on the efficiency and quality of health care delivery - across Medicare, Medicaid, HEDIS quality measurements and other healthcare avenues.

This role is a Data Quality Lead, and will be joining a small team of Data Analysts/Scientists. The primary responsibility will be to design a scalable and automated Data Validation process for Healthcare Claims data feeding into a Cloud Data ecosystem.

The ideal candidate will have a unique combination of Data Quality, Data Engineering and Data Science surrounding the niche of Healthcare Claims Data (EDI transactions, CPT codes, NCI codes)

RESPONSIBILITIES

• Working as a member of a small team (<5 people), reporting to a Manager of Data Science
• Designing an end to end process for data quality and testing
• Developing an automated testing framework for Healthcare Claims Data using historical data to identify values and outliers
• Working with a strong knowledge and understanding of Healthcare Claims -- EDI transactions, CPT codes, NC and NCI codes, Provider Identifiers, etc.
• Creating the specs and business requirements for validating the specific claims data against
• Deciphering which metrics, business roles, specs, ranges to include in the validations
• Determining what the reference values will be
• Using Python and SQL to extract, manipulate claims data
• Running Monte Carlo simulations, Random Forest, Segmentation analysis to identify outliers to be incorporated into the automated testing
• Working within a Cloud Data ecosystem that involves Python, PySpark, Databricks, Apache Airflow, etc
• Serving as a coach and mentor to 2 other Data Analysts on the team

REQUIRED QUALIFICATIONS

• 10+ years of professional experience
• Minimum 3-5 years experience in Healthcare Claims data (EDI, CPT, NCI codes)
• Prior experience designing the requirements for data validation and quality assurance
• Experienced with Python and SQL
• Experienced with Statistical Modeling / Machine Learning
• Cloud Data experience - Databricks, Snowflake, Airflow preferred
  
  

Please note - candidates must be eligible to work directly for our client without the need for visa sponsorship now, or in the future.

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.