GENERAL PROFESSIONAL IV (MED-QUEST DATA ANALYST) - EWA, OAHU

About the role

The current vacancy position is a permanent, full-time position with the Department of Human Services, Med-Quest Division. THIS JOB POSTING WILL REMAIN OPEN UNTIL 40 APPLICATIONS ARE RECEIVED. PLEASE APPLY IMMEDIATELY AS THIS RECRUITMENT MAY CLOSE AT ANY TIME.

Responsibilities

• Independently performs complex professional work which involves considerable research and analysis of a variety of issues, identification of various options and recommendation of the most viable solution.
• Conducts data analysis in support of the Division's statewide surveillance and utilization control program of program integrity functions to identify potential fraud and abuse by Medicaid program providers.
• Analyzes and evaluates surveillance and utilization review subsystem reports, providers' records, claims and other related materials, current trends in provider abuse and fraud, complaints against providers, etc., to determine the scope, parameters and variables for data analyses.
• Analyzes and interprets any identified anomalies, aberrancies, outliers, etc., and verifies or corroborates with data, records, claims, files, program providers, etc., to determine whether the utilization of services and providers' claims and billings represent potential fraud and abuse.
• Refers cases involving possible fraud and abuse for preliminary investigation by MQD investigative staff.
• Prepares summaries and reports with data.
• Maintains accurate and updated fraud and abuse reports, records, and referrals.
• Performs other related duties as assigned.

Requirements

• Legal Authorization To Work: The State of Hawaii requires all persons seeking employment with the government of the State shall be citizens, nationals, or permanent resident aliens of the United States, or eligible under federal law for unrestricted employment in the United States.
• Basic Education: Bachelor's degree from an accredited four-year college or university.
• General Experience: One (1) year of responsible professional work experience which required a high degree of analytical skill.
• Selective Certification Requirement (Med-QUEST Data Analyst Experience): In order to effectively perform the duties and responsibilities of this position, applicants must possess demonstrated knowledge of methods and tools of data analysis such as using data mining, data or database queries, statistically valid samplings, etc., of information or data such as health care providers' billings, diagnosis codes, procedural codes, health care provider information, etc.; statistical and quantitative analysis methods to determine cause and effect; computer applications including data analysis and statistical applications (e.g., LexisNexis Intelligent Investigator, IBM Cognos, SAS, Access, Excel, etc.); and the skill to interpret and summarize such data, information and findings; prepare clear and concise reports of findings; and organize large data sets with accuracy and attention to detail.
• Supervisory Aptitude: Supervisory aptitude rather than actual supervisory experience may be accepted. This requirement will be considered to have been met when there is strong affirmative evidence of the necessary supervisory abilities and/or potential.

Qualifications

• Relevant substitution as described in the Minimum Qualification Requirements, will apply.

Skills

• Knowledge of methods and tools of data analysis such as using data mining, data or database queries, statistically valid samplings, etc., of information or data such as health care providers' billings, diagnosis codes, procedural codes, health care provider information, etc.
• Statistical and quantitative analysis methods to determine cause and effect.
• Computer applications including data analysis and statistical applications (e.g., LexisNexis Intelligent Investigator, IBM Cognos, SAS, Access, Excel, etc.).
• The skill to interpret and summarize such data, information and findings.
• Prepare clear and concise reports of findings.
• Organize large data sets with accuracy and attention to detail.

Benefits

Note: Hiring rates will be based on availability of funds, the applicant's qualifications, and other relevant factors.

Pay

$5,527 to $6,728 per month (SR-22, Step D to I)

Schedule

N/A