Data Science Prior Authorization Reporting Lead (DSIS3/SPI) – Internal

About the role

The Data Science Prior Authorization Reporting Lead applies advanced statistical techniques, mathematical modeling, and specialized programming to extract actionable insights from complex health care data in support of Apple Health’s prior authorization program. The position develops data storytelling and analytics to inform policy decisions and improve health care outcomes using tools like Power BI, Tableau, SQL, R, and Python.

Responsibilities

• Generate high quality data products from structured and unstructured data sources using programming languages such as R, SAS, SQL, M code and/or Python to write data code/query scripts.
• Lead the development of advanced algorithms, build data models, and automate data processing tasks.
• Develop complex data quality processes and metrics to ensure accurate and timely reporting to Centers for Medicare and Medicaid Services (CMS) and the Washington state legislature.
• Lead multiple complex data science projects in collaboration with internal and external partners.
• Use and oversee the use of tools such as R, Power BI and/or Tableau to develop data models and interactive visualizations.
• Ensure overall compliance with agency process and external policy and/or legal requirements while assuring accuracy and completion of analytic projects.
• Maintain a participatory process by involving staff in decisions affecting them.
• Mentor staff members to build their knowledge and skills as it relates to analytical techniques, agency programs, data infrastructure, processes and best practices.
• Serve as expert of the use of advanced quantitative research methods commonly used in scientific, surveillance, and/or epidemiological research to analyze and interpret data.
• Serve as key data science technical expert for the agency, within the prior authorization team.
• Provide advice and consultation on agency data policy development and strategic recommendations.
• Review proposal plans and implementation activities for statistical analysis such as regression analysis, clustering, or time series analysis.
• Mentor journey or entry level data scientists through peer review, constructive feedback and knowledge sharing.
• Provide expert consultation on how to manage analytic barriers, opportunities and implement innovations.
• Oversee the gathering, prioritizing, and validation of data requirements.
• Provide consultation to agency leadership regarding data access, feasibility, statistical validity, etc.
• Determine resolution of complex issues, using innovated methods to solve complex technical challenges.
• Develop innovative and effective approaches to solve requestors analytics problems.
• Assess statistical approaches, tools and methods for feasibility, relevancy and effectiveness.
• Troubleshoot highly complex issues in a timely fashion and minimizes disruption of data transmission.
• Inform complex data definitions and logic models for analysis and measures.
• Oversee staff data validity checks to identify and report anomalies in the data.
• Propose and lead technical solutions, informed by health care systems knowledge.

Qualifications

• Master’s degree or higher in informatics, data science, mathematics, computer science, statistics, biostatistics, epidemiology, or related technical or quantitative field, and one (1) year of experience performing data science or informatics data work, within health care, public health, and/or behavioral health. Experience must include at least one (1) year working with complex analytics, data visualization software and R, SAS, SQL, M code and/or Python programming.
• Bachelor's degree in a field identified above, and three (3) years of experience performing data science or informatics data work, within health care, public health, and/or behavioral health. Experience must include at least three (3) years working with complex analytics, data visualization software and R, SAS, SQL, M code and/or Python programming.
• Seven (7) years of experience performing data science or informatics data work, within health care, public health, and/or behavioral health. Experience must include at least three (3) years working with complex analytics, data visualization software and R, SAS, SQL, M code and/or Python programming.

Preferred Qualifications

• Deep knowledge of medical and/or pharmacy coding such as ICD-10, Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes; health care business and systems, including health care prior authorization processes.
• Demonstrated ability to work effectively in a multi-disciplinary team, comfortable interacting technically and politically with staff members at all levels of the agency.
• Demonstrated high level of workload & project management including organization and prioritization of tasks.
• Excellent technical written and verbal communication skills, and visual story-telling through dashboards, reports, and data visualizations.
• Significant experience working with large and complex data sets; advanced level SQL, R, Python, SAS or other programming skills; significant experience with data visualization using Power BI, Tableau and other similar visualization tools.