Data Science & Informatics Specialist 1, Medicaid ...

OverviewPosition and Salary: The Attorney General’s Office is recruiting for a permanent full time Data Scientist in the Medicaid Fraud Control Division. This position is located in Olympia, Washington, and is represented by the Washington Federation of State Employees (WFSE).Data Science & Informatics Specialist 1 Salary Range 68: $84,984 - $114,264. 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 & dependents; Vacation, Sick, and Other Leave; 11 Paid Holidays per year; Public Employees Retirement System (PERS) plans; and Life Insurance, with additional programs such as Dependent Care Assistance, Flexible Spending Accounts, Public Service Loan Forgiveness, Tuition Waiver, Deferred Compensation, and more.There are flexible schedules and part-time/hybrid telework options, a Wellness Program, Infants in the Workplace Program, and the Employee Assistance Program, plus numerous employee-driven affinity groups.About the Medicaid Fraud Control DivisionThe 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 in Olympia, with team members also in Spokane and Seattle. The Division has about 60 FTEs including attorneys, auditors, special agents, data analysts, clinical health investigators and professional support staff. MFCD protects the Medicaid program and its most vulnerable persons, typically the elderly in residential facilities or those abused or neglected by a Medicaid Provider.Our cases range from abuse/neglect in nursing homes to large-scale fraud; MFCD operates with lawyers, special agents, data analysts, and supporting staff working as a cohesive team.Duties and Essential Functions of a Data Science & Informatics Specialist 1Perform research, querying, and analysis of complex Medicaid claim and encounter data; review financial, billing and healthcare records to identify trends, anomalies and patterns indicative of fraud.Assist in designing, writing and executing data queries utilizing SQL and other programming languages to query Medicaid data.Assist in the design and implementation of advanced statistical models and data algorithms.Assist in investigative steps to identify, research and assess allegations of fraudulent billings and/or other issues.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 intake or from warrants and Civil Investigative Demands.Collaborate with senior data scientists to review analytical reports, spreadsheets, data visualizations and related documents.Maintain all reports, documents, spreadsheets, correspondence and other pertinent documentation in electronic format.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.QualificationsBachelor's degree in informatics, data science, mathematics, computer science, statistics, biostatistics, epidemiology, or a related technical or quantitative field, and one (1) year of experience performing data science or informatics data work. Experience in a specialty area such as public health or healthcare and/or data visualization/software may be desired. Additional qualifying experience may substitute year for year for required education.Preferred Certification: Certified Public Accountant (CPA), Accredited Financial Examiner (AFE) or Certified Financial Examiner (CFE)Skills & AbilitiesProficiency with Microsoft Excel, including macros, advanced filters, and links to external sources.Basic knowledge of medical coding terminology and systems (CPT, HCPCS, ICD9, ICD10).Basic knowledge of medical billings.Experience with Microsoft Word, Outlook, Access; and Adobe Acrobat.Desirable knowledge of RAT-STATS, SQL, and SAS.Knowledge of financial/data analytics.Conditions of EmploymentA background check including employment history, professional references and education verification may be conducted. Prior to any offer, the applicant will submit to fingerprint-based criminal background checks and additional background checks every five years thereafter.Equal Employment Opportunity & AccommodationsThe AGO is an equal opportunity employer and does not discriminate. Persons requiring reasonable accommodation in the application process or information in an alternative format may contact the recruitment team at . Hearing impairments may contact the Washington Relay Service at 1-800-676-3777 or regarding this recruitment or assistance with the application process may be directed to the recruitment team at . If you are having technical difficulties with your application, please call NEOGOV at (855) 524-5627 or . #J-18808-Ljbffr

Created: 2025-09-23