Data Science & Informatics Specialist 2, Medicaid Fraud Control Division, Olympia

Full Job Description

Persons requiring reasonable accommodation in the application process or requiring information in an alternative format may contact the recruitment team at HREmployment@atg.wa.gov.

Those with a hearing impairment in need of accommodation are encouraged to contact the Washington Relay Service at 1-800-676-3777 or www.washingtonrelay.com.

Position and Salary

The Attorney General’s Office is recruiting for a permanent full time Data Science & Informatics Specialist 2 in the Medicaid Fraud & Abuse Division. This position is located in Olympia, Washington, and is represented by the Washington Federation of State Employees (WFSE).

Data Science & Informatics Specialist 2 Salary Range 72: $93,804 - $126,168
The base pay offered will take into account internal equity and may vary depending on the preferred candidate’s job-related knowledge, skills, and experience.

The AGO provides a workplace that is understanding of work-life balance and promotes advancement by offering a wide variety of professional development and growth opportunities.

Excellent benefits Washington State offers one of the most competitive benefits packages in the nation, including Medical/Dental/Vision for employees & dependent(s); Vacation, Sick, and Other Leave; 11 Paid Holidays per year; Public Employees Retirement System (PERS) plans; and Life Insurance.

Beyond these traditional benefits, we offer Dependent Care Assistance, Flexible Spending Accounts, Public Service Loan Forgiveness, Tuition Waiver, Deferred Compensation, Employee Recognition Leave, and more.

With the goal of employee health and wellness, we also offer:

• Flexible schedules and part-time/hybrid telework options;
• A Wellness Program, an Infants in the Workplace Program, and the Employee Assistance Program, which provides counseling, webinar, and other cost-free support resources;
• Numerous employee-driven affinity groups to foster community and connection, including Bereavement, Elder Care, Parenting, POC, LGBTQ+, Veterans and more. The AGO is a place to belong and make a difference!

About the Medicaid Fraud & Abuse Division

The work of the Office’s Medicaid Fraud Control Division (MFCD) focuses on both criminal and civil law enforcement. The 75% federally funded MFCD‘s mission is combating provider fraud, abuse and neglect in residential facilities and involving Medicaid recipients in non-institutional settings.

MFCD’s Headquarters is located in Olympia, Washington with some team members also located at the AGO's Spokane Office and Seattle Office.

The Division currently has a staff of 60 FTEs, including attorneys, auditors, special agents, data analysts, clinical health investigators and professional support staff.

MFCD involves protecting not only the Medicaid program of roughly 13 billion dollars per annum, but also its most vulnerable persons, typically elderly persons in residential facilities or persons abused or neglected by a Medicaid Provider.

In many of our cases, there is no precedent so MFCD is consistently on the cutting edge of legal theories and issues.

The cases range from abuse and neglect of persons in nursing homes, large scale organized individual and corporate civil and criminal fraudulent activity to national whistleblower actions.

Our staff is a highly professional, fun and seasoned analytical investigative team. MFCD is unique in that all cases have an attorney, special agent, data analyst assigned with legal support.

This, and the great people who make up the division, gives MFC a particularly terrific team atmosphere.

Duties and Essential Functions of a Data Science & Informatics Specialist 2

Perform research, querying, and analysis of complex Medicaid claim and encounter data; review financial, billing and healthcare records to identify and detect trends, anomalies and patterns indicative of fraud.

• Conduct investigative steps to identify, research and assess allegations of fraudulent billings and/or other issues.
• Design, write and execute data queries utilizing SQL and other available programming language to query Medicaid data.
• Designs and implements advanced statistical models and data algorithms.
• Use developed SQL queries and software applications to conduct complex quantitative and qualitative analysis to identify potential fraud schemes for case development.
• Analyze complex healthcare service claim and encounter data to determine utilization of complaint/allegation and respond to data requests.
• Research Medicaid billing and program guides, policies, state and federal regulations; payment methodologies; billed medical, dental and social services procedure and applicable modifier codes; and diagnosis codes.
• Research and understand medical coding systems and guidelines for CPT, HCPCS, ICD, DRG, EAPG, etc.; and the use and application of these codes to identify billing and coding irregularities.
• Examine, analyze and research financial and billing documents; audit documents, and healthcare records obtained during the intake process, and/or collected from search warrants and Civil Investigative Demands.
• Build concise and factual electronic investigative or analytical reports, spreadsheets, data visualizations and associated documents.
• Maintain all reports, documents, spreadsheets, correspondence and other pertinent documentation in electronic format.
• Determine valid conclusions and develop appropriate recommendations.
• Ensure data accuracy, system function, interfaces, code frameworks and interactive functionality for database data.
• Assist with developing, designing and maintaining back-end data for analytic reports in Fraud Analytic Product Solution.

There will be a full training program to assist you with becoming familiar with the data and how to query Medicaid data. If you’re looking for a great place to work with positive environment, then this is the job for you!

This recruitment announcement may be used to fill multiple open positions for the same classification, in addition to the position(s) listed in this announcement.

Required Qualifications

Master's degree in informatics, data science, mathematics, computer science, statistics, biostatistics, epidemiology, or related technical or quantitative field.

OR

Bachelor's degree in informatics, data science, mathematics, computer science, statistics, biostatistics, epidemiology, or related technical or quantitative field, and two (2) years of professional experience performing data science or informatics data work.

OR

Equivalent years of relevant experience.

Additional qualifying experience may substitute year for year, for required education

Skills & Abilities

• Proficiency with Microsoft Excel, with the ability to develop complex spreadsheets with macros, multiple math functions, advanced filters, and links to external sources of information.
• Basic skills and experience with medical coding terminology and systems (CPT, HCPCS, ICD9, ICD10).
• Basic skills and experience with Microsoft Word, Microsoft Outlook, Microsoft Access; and experience with Adobe Acrobat, which includes converting Microsoft Office files to .pdf files.
• Most desirable candidates will have working knowledge of RAT-STATS, SQL, and SAS.
• A minimum of 24 semester or 36 quarter hours in accounting is desirable.
• Certification as a Certified Public Accountant or Certified Fraud Examiner is desirable.

Conditions of Employment

A background check consisting of employment history, professional references and educational verification (e.g., degree, license, or official transcript) may be conducted.

Prior to any offer, the applicant selected will be required to submit to and pass a fingerprint-based criminal background check conducted by the Washington State Patrol, Criminal Records Division.

The incumbent will submit to additional background checks as a condition of employment every five (5) years thereafter.

About the Washington State Office of the Attorney General The Attorney General’s Office (AGO) touches the lives of every resident in this state.

We serve more than 230 state agencies, boards, commissions, colleges and universities, as well as the Legislature and the Governor.

The Office is comprised of nearly 700 attorneys and 800 professional staff, all working together to deliver the highest quality professional legal services to Washington state officials, agencies, and entities.

This includes:

• Economic justice and consumer protections (safeguarding consumers, protecting youth, seniors, and other vulnerable populations)
• Social justice and civil rights (addressing discrimination, environmental protection, and veteran and military resources)
• Criminal justice and public safety (investigative and prosecutorial support, financial crimes)
• And much more!

Our agency also has national reach, representing the State of Washington before the Supreme Court, the Court of Appeals and trial courts in all cases that involve the state’s interest. If you want to make a difference, we may be the perfect fit for you! Learn more about the AGO here.

Commitment to Diversity Diversity is critical to the success of the mission of the AGO.

This means recognizing, respecting, and appreciating all cultures and backgrounds-- and fostering the inclusion of differences between people.

Appreciating, valuing and implementing principles of diversity permits AGO employees to achieve their fullest potential in an inclusive, respectful environment.

One recent measure of the AGO's commitment to diversity can be found in its nomination for Rainbow Alliance and Inclusion Network's "Outstanding Agency Award" in 2019.

Our commitment to employee wellness is reflected in earning the 2024 Zo8 Washington Wellness Award.

Application Instructions

In addition to completing the online application, applicants must attach the following documents to their profile in order to be considered for this position:

• A letter of interest, describing your specific qualifications for the position;
• A current resume detailing experience and education.

Read the Following Information Completely:

• Carefully review your application for accuracy, spelling and grammar before submitting.
• You may not reapply to this posting for 30 days.
• The initial screening of applications will be solely based on the contents and completeness of the “work experience” and “education” sections of your application in www.careers.wa.gov, completeness of the application material submitted, and responses to the supplemental questionnaire.
• A resume will not substitute for completing the “work experience” section of the application.
• All information may be verified and documentation may be required.
• The Washington State Office of the Attorney General does not use the E-Verify system; therefore, we are not eligible to extend STEM Optional Practical Training (OPT). For more information, please visitwww.uscis.gov.

Equal Employment Opportunity and Accommodations Requests

Honoring diversity, equity and inclusion means that as an agency, and as individuals, we are committed to ensuring that all employees and volunteers enjoy a respectful, safe and supportive working environment.

Only by fostering the inclusion of people from all backgrounds, cultures and attributes, can AGO employees and volunteers achieve their fullest potential and best advance the goals and mission of the AGO.

The AGO is an equal opportunity employer and does not discriminate on the basis of race, creed, color, national origin, sex, marital status, sexual orientation/gender identity, age, disability, honorably discharged veteran or military status, retaliation or the use of a trained dog guide or service animal by a person with a disability.

Persons requiring reasonable accommodation in the application process or requiring information in an alternative format may contact the recruitment team at HREmployment@atg.wa.gov.

Those with a hearing impairment in need of accommodation are encouraged to contact the Washington Relay Service at 1-800-676-3777 or www.washingtonrelay.com.

For questions regarding this recruitment or assistance with the application process, please contact the recruitment team at HREmployment@atg.wa.gov.

If you are having technical difficulties creating, accessing or completing your application, please call NEOGOV toll-free at (855) 524-5627 or support@neogov.com.